Provider Demographics
NPI:1205148186
Name:WHITE, BEVERLY KAY (LMFT)
Entity type:Individual
Prefix:MS
First Name:BEVERLY
Middle Name:KAY
Last Name:WHITE
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 1:129 PRIVATE ROAD 4435
Mailing Address - Street 2:
Mailing Address - City:RHOME
Mailing Address - State:TX
Mailing Address - Zip Code:76078-2606
Mailing Address - Country:US
Mailing Address - Phone:940-447-7446
Mailing Address - Fax:
Practice Address - Street 1:129 PRIVATE ROAD 4435
Practice Address - Street 2:
Practice Address - City:RHOME
Practice Address - State:TX
Practice Address - Zip Code:76078-2606
Practice Address - Country:US
Practice Address - Phone:940-447-7446
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-07-08
Last Update Date:2023-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAIMF 72395106H00000X
TX203077106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist