Provider Demographics
NPI:1538307129
Name:LITTAU, BEVERLY JEAN (MFT)
Entity Type:Individual
Prefix:MRS
First Name:BEVERLY
Middle Name:JEAN
Last Name:LITTAU
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 8062
Mailing Address - Street 2:
Mailing Address - City:WOODLAND
Mailing Address - State:CA
Mailing Address - Zip Code:95776-8062
Mailing Address - Country:US
Mailing Address - Phone:530-304-4485
Mailing Address - Fax:
Practice Address - Street 1:825 EAST ST
Practice Address - Street 2:SUITE 117
Practice Address - City:WOODLAND
Practice Address - State:CA
Practice Address - Zip Code:95776-4976
Practice Address - Country:US
Practice Address - Phone:530-304-4485
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-04
Last Update Date:2009-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA39409106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist