Provider Demographics
NPI:1922077791
Name:WHITE, BEVERLY DIANNE (MED, LPC)
Entity type:Individual
Prefix:
First Name:BEVERLY
Middle Name:DIANNE
Last Name:WHITE
Suffix:
Gender:F
Credentials:MED, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5148 SAGE THRASHER RD
Mailing Address - Street 2:
Mailing Address - City:PARKER
Mailing Address - State:CO
Mailing Address - Zip Code:80134-2778
Mailing Address - Country:US
Mailing Address - Phone:303-246-5044
Mailing Address - Fax:720-255-2749
Practice Address - Street 1:19563 E MAINSTREET
Practice Address - Street 2:SUITE 206-H
Practice Address - City:PARKER
Practice Address - State:CO
Practice Address - Zip Code:80138-7394
Practice Address - Country:US
Practice Address - Phone:303-246-5044
Practice Address - Fax:720-255-2749
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-15
Last Update Date:2011-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO3088101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional