Provider Demographics
NPI:1598139727
Name:STRATTON, BEVERLY (MA, THD)
Entity Type:Individual
Prefix:
First Name:BEVERLY
Middle Name:
Last Name:STRATTON
Suffix:
Gender:F
Credentials:MA, THD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1611 COUNTY ROAD B W STE 303
Mailing Address - Street 2:
Mailing Address - City:ROSEVILLE
Mailing Address - State:MN
Mailing Address - Zip Code:55113-4104
Mailing Address - Country:US
Mailing Address - Phone:651-395-0090
Mailing Address - Fax:651-340-4597
Practice Address - Street 1:1611 COUNTY ROAD B W STE 303
Practice Address - Street 2:
Practice Address - City:ROSEVILLE
Practice Address - State:MN
Practice Address - Zip Code:55113-4104
Practice Address - Country:US
Practice Address - Phone:651-395-0090
Practice Address - Fax:651-340-4597
Is Sole Proprietor?:Yes
Enumeration Date:2015-11-27
Last Update Date:2016-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
MN01785101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health