Provider Demographics
NPI:1659448785
Name:STOTT, BEVERLY GORE (MA, LPC)
Entity Type:Individual
Prefix:MS
First Name:BEVERLY
Middle Name:GORE
Last Name:STOTT
Suffix:
Gender:F
Credentials:MA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2917 PARK WEST HTS
Mailing Address - Street 2:
Mailing Address - City:CAPE GIRARDEAU
Mailing Address - State:MO
Mailing Address - Zip Code:63703-5005
Mailing Address - Country:US
Mailing Address - Phone:573-334-4800
Mailing Address - Fax:
Practice Address - Street 1:2917 PARK WEST HTS
Practice Address - Street 2:
Practice Address - City:CAPE GIRARDEAU
Practice Address - State:MO
Practice Address - Zip Code:63703-5005
Practice Address - Country:US
Practice Address - Phone:573-334-4800
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO000367101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional