Provider Demographics
NPI:1881282952
Name:THE BEVERLY CENTER FOR TRAUMA THERAPY, PLLC
Entity type:Organization
Organization Name:THE BEVERLY CENTER FOR TRAUMA THERAPY, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED MENTAL HEALTH COUNSELOR
Authorized Official - Prefix:
Authorized Official - First Name:EMBERLY
Authorized Official - Middle Name:JOE
Authorized Official - Last Name:LASHLEY
Authorized Official - Suffix:
Authorized Official - Credentials:NCC LMHC
Authorized Official - Phone:480-232-4076
Mailing Address - Street 1:155 GLENDALE DR
Mailing Address - Street 2:
Mailing Address - City:WAUKEE
Mailing Address - State:IA
Mailing Address - Zip Code:50263-8534
Mailing Address - Country:US
Mailing Address - Phone:480-232-4076
Mailing Address - Fax:
Practice Address - Street 1:7405 UNIVERSITY AVE STE 10
Practice Address - Street 2:
Practice Address - City:CLIVE
Practice Address - State:IA
Practice Address - Zip Code:50325-1343
Practice Address - Country:US
Practice Address - Phone:515-650-6844
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-01-05
Last Update Date:2024-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty