Provider Demographics
NPI:1649417049
Name:THOMAS-MARSH, BEVERLY DENISE (MS, LMFT)
Entity Type:Individual
Prefix:
First Name:BEVERLY
Middle Name:DENISE
Last Name:THOMAS-MARSH
Suffix:
Gender:F
Credentials:MS, LMFT
Other - Prefix:
Other - First Name:BEVERLY
Other - Middle Name:DENISE
Other - Last Name:THOMAS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MS, LMFT
Mailing Address - Street 1:6700 INDIANA AVE STE 165
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92506-4248
Mailing Address - Country:US
Mailing Address - Phone:951-456-3939
Mailing Address - Fax:951-456-3939
Practice Address - Street 1:6700 INDIANA AVE STE 165
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92506-4248
Practice Address - Country:US
Practice Address - Phone:951-456-3930
Practice Address - Fax:951-456-3939
Is Sole Proprietor?:No
Enumeration Date:2009-01-07
Last Update Date:2019-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA91502101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1649417049Medicaid
CA1649417049OtherMEDI-CAL