Provider Demographics
NPI:1700054723
Name:BEVERLY, HARRY JOHN (PHD)
Entity Type:Individual
Prefix:DR
First Name:HARRY
Middle Name:JOHN
Last Name:BEVERLY
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2304 BENNINGTON
Mailing Address - Street 2:
Mailing Address - City:MCKINNEY
Mailing Address - State:TX
Mailing Address - Zip Code:75070-4562
Mailing Address - Country:US
Mailing Address - Phone:972-540-0585
Mailing Address - Fax:
Practice Address - Street 1:1615 W LOUISIANA ST
Practice Address - Street 2:
Practice Address - City:MCKINNEY
Practice Address - State:TX
Practice Address - Zip Code:75069-7857
Practice Address - Country:US
Practice Address - Phone:469-424-1618
Practice Address - Fax:972-542-6198
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-12
Last Update Date:2015-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX9917101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional