Provider Demographics
NPI:1548379639
Name:BEVILLE, BARBARA ANN (LCSW)
Entity Type:Individual
Prefix:MS
First Name:BARBARA
Middle Name:ANN
Last Name:BEVILLE
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1423 N GOVERNMENT WAY
Mailing Address - Street 2:
Mailing Address - City:COEUR D ALENE
Mailing Address - State:ID
Mailing Address - Zip Code:83814-3335
Mailing Address - Country:US
Mailing Address - Phone:208-765-3400
Mailing Address - Fax:208-683-5213
Practice Address - Street 1:1423 N GOVERNMENT WAY
Practice Address - Street 2:
Practice Address - City:COEUR D ALENE
Practice Address - State:ID
Practice Address - Zip Code:83814-3335
Practice Address - Country:US
Practice Address - Phone:208-765-3400
Practice Address - Fax:208-683-5213
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2012-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLCSW9511041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IDL5808OtherBLUE CROSS
ID000010144733OtherREGENCE BS
ID0028657Medicaid
CS6290Medicare Oscar/Certification
ID000010144733OtherREGENCE BS