Provider Demographics
NPI:1730673450
Name:BEVIL, KISHAN LAVELL (MSW, LCSW)
Entity Type:Individual
Prefix:MR
First Name:KISHAN
Middle Name:LAVELL
Last Name:BEVIL
Suffix:
Gender:M
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:14545 FRIAR ST STE 101AA
Mailing Address - Street 2:
Mailing Address - City:VAN NUYS
Mailing Address - State:CA
Mailing Address - Zip Code:91411-2397
Mailing Address - Country:US
Mailing Address - Phone:818-602-2894
Mailing Address - Fax:818-495-4344
Practice Address - Street 1:44300 LOWTREE AVE STE 200
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:CA
Practice Address - Zip Code:93534-4168
Practice Address - Country:US
Practice Address - Phone:661-418-5093
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-16
Last Update Date:2021-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAASW365511041C0700X
CALCSW940741041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical