Provider Demographics
NPI:1619085594
Name:DAVIS, BEVERLY MAE (PHD)
Entity Type:Individual
Prefix:
First Name:BEVERLY
Middle Name:MAE
Last Name:DAVIS
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12922 VISTA HVN
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78216-1703
Mailing Address - Country:US
Mailing Address - Phone:210-492-7855
Mailing Address - Fax:210-494-4215
Practice Address - Street 1:12922 VISTA HVN
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78216-1703
Practice Address - Country:US
Practice Address - Phone:210-492-7855
Practice Address - Fax:210-494-4215
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX23435101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00D78BMedicare ID - Type Unspecified