Provider Demographics
NPI:1871643767
Name:WORLEY, BEVERLY H (MA,LPC,LMFT)
Entity Type:Individual
Prefix:MS
First Name:BEVERLY
Middle Name:H
Last Name:WORLEY
Suffix:
Gender:F
Credentials:MA,LPC,LMFT
Other - Prefix:MS
Other - First Name:BEVERLY
Other - Middle Name:JUNE
Other - Last Name:WORLEY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:5608 MALVEY AVE
Mailing Address - Street 2:SUITE 306
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76107-5100
Mailing Address - Country:US
Mailing Address - Phone:817-996-8890
Mailing Address - Fax:817-737-5757
Practice Address - Street 1:5608 MALVEY AVE
Practice Address - Street 2:SUITE 306
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76107-5100
Practice Address - Country:US
Practice Address - Phone:817-996-8890
Practice Address - Fax:817-737-5757
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX09390101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional