Provider Demographics
NPI:1184947921
Name:BEATTY, KIMBERLY LYNNE (LCSW)
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:LYNNE
Last Name:BEATTY
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:302 E MAIN ST
Mailing Address - Street 2:STE 210
Mailing Address - City:LEAGUE CITY
Mailing Address - State:TX
Mailing Address - Zip Code:77573-3743
Mailing Address - Country:US
Mailing Address - Phone:832-769-6703
Mailing Address - Fax:
Practice Address - Street 1:302 E MAIN ST
Practice Address - Street 2:STE 210
Practice Address - City:LEAGUE CITY
Practice Address - State:TX
Practice Address - Zip Code:77573-3743
Practice Address - Country:US
Practice Address - Phone:832-769-6703
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-08
Last Update Date:2019-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker