Provider Demographics
NPI:1609206382
Name:BEVERLY, TOYAH (MA, LPC,LMFT)
Entity Type:Individual
Prefix:
First Name:TOYAH
Middle Name:
Last Name:BEVERLY
Suffix:
Gender:F
Credentials:MA, LPC,LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3005 S LAMAR BLVD
Mailing Address - Street 2:STE-D 109 #318
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78704-8864
Mailing Address - Country:US
Mailing Address - Phone:512-721-0417
Mailing Address - Fax:
Practice Address - Street 1:3005 S LAMAR BLVD
Practice Address - Street 2:STE-D 109 #318
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78704-8864
Practice Address - Country:US
Practice Address - Phone:512-721-0417
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-11-18
Last Update Date:2016-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX68460101YP2500X
TX201779106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional