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
State | License ID | Taxonomies |
---|---|---|
ID | LCSW951 | 1041C0700X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 1041C0700X | Behavioral Health & Social Service Providers | Social Worker | Clinical |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
ID | L5808 | Other | BLUE CROSS |
ID | 000010144733 | Other | REGENCE BS |
ID | 0028657 | Medicaid | |
CS6290 | Medicare Oscar/Certification | ||
ID | 000010144733 | Other | REGENCE BS |