Provider Demographics
NPI:1912036088
Name:HALL, BEVERLY EDGREN (LMFT)
Entity Type:Individual
Prefix:
First Name:BEVERLY
Middle Name:EDGREN
Last Name:HALL
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:212 PARK PL
Mailing Address - Street 2:
Mailing Address - City:SAN RAMON
Mailing Address - State:CA
Mailing Address - Zip Code:94583-5373
Mailing Address - Country:US
Mailing Address - Phone:925-891-8791
Mailing Address - Fax:
Practice Address - Street 1:931 HARTZ WAY
Practice Address - Street 2:SUITE 130
Practice Address - City:DANVILLE
Practice Address - State:CA
Practice Address - Zip Code:94526-3465
Practice Address - Country:US
Practice Address - Phone:925-891-8791
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-05
Last Update Date:2007-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC 37566106H00000X
CARN 381567163WG0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice