Provider Demographics
NPI:1174071526
Name:BEVERLY J. TRICKEY LPC
Entity type:Organization
Organization Name:BEVERLY J. TRICKEY LPC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BEVERLY
Authorized Official - Middle Name:J
Authorized Official - Last Name:TRICKEY
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:501-860-1114
Mailing Address - Street 1:176 MAPLELEAF CIR
Mailing Address - Street 2:
Mailing Address - City:HOT SPRINGS
Mailing Address - State:AR
Mailing Address - Zip Code:71901-3300
Mailing Address - Country:US
Mailing Address - Phone:501-860-1114
Mailing Address - Fax:
Practice Address - Street 1:176 MAPLELEAF CIR
Practice Address - Street 2:
Practice Address - City:HOT SPRINGS
Practice Address - State:AR
Practice Address - Zip Code:71901-3300
Practice Address - Country:US
Practice Address - Phone:501-860-1114
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-14
Last Update Date:2016-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARP0304017251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR5X382OtherARKANSAS BLUECROSS BLUESHIELD
AR173117795Medicaid
AR1043282056OtherINDIVIDUAL NPI