Provider Demographics
NPI:1952189458
Name:BEVERS, EMRESS (LPC-A)
Entity Type:Individual
Prefix:
First Name:EMRESS
Middle Name:
Last Name:BEVERS
Suffix:
Gender:F
Credentials:LPC-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9525 W AMARILLO BLVD
Mailing Address - Street 2:
Mailing Address - City:AMARILLO
Mailing Address - State:TX
Mailing Address - Zip Code:79124-2329
Mailing Address - Country:US
Mailing Address - Phone:806-414-0484
Mailing Address - Fax:
Practice Address - Street 1:9525 W AMARILLO BLVD
Practice Address - Street 2:
Practice Address - City:AMARILLO
Practice Address - State:TX
Practice Address - Zip Code:79124-2329
Practice Address - Country:US
Practice Address - Phone:806-414-0484
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-18
Last Update Date:2023-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX87018101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional