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DR. WILLIAM TEMPLE BEVERLY LCSW, PHD
Clinical >> Social Worker >> Behavioral Health & Social Service ProvidersRegistrant NPI Number: 1184930117
Individual Registrant:DR. WILLIAM TEMPLE BEVERLY LCSW, PHD
Gender: M
Sole Proprietor
Gender: M
Sole Proprietor
Location and contact information for practice:
100 W 4TH ST WALSENBURG, CO 81089-1910 US
Tel: 719-671-7793 Fax: 877-359-1299
Tel: 719-671-7793 Fax: 877-359-1299
Contact information for business:
PO BOX 871 WALSENBURG, CO 81089-0871 US
Tel: 719-671-7793 Fax: --
Tel: 719-671-7793 Fax: --
Registration Information:
NPI: 1184930117
Entity Type: Individual
Entity Type: Individual
Specialty information:
| Primary | Code | Category/Description | State | License Number |
|---|---|---|---|---|
| Y | 1041C0700X | Behavioral Health & Social Service Providers Social Worker Clinical | CO | CSW-1510 |
| N | 1041S0200X | Behavioral Health & Social Service Providers Social Worker | CO | 0473664 |
Legacy codes, insurance codes and state license numbers:
| Issuer | Number | State | Type |
|---|---|---|---|
| VALUE OPTIONS, MEDICAID | 701760 | CO | 01 |
| 49330888 | CO | 05 |
