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DR. WILLIAM TEMPLE BEVERLY LCSW, PHD

Clinical >> Social Worker >> Behavioral Health & Social Service Providers

Registrant NPI Number: 1184930117

Individual Registrant:
DR. WILLIAM TEMPLE BEVERLY LCSW, PHD
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

Contact information for business:
PO BOX 871  WALSENBURG, CO 81089-0871 US
Tel: 719-671-7793  Fax: --

Registration Information:
NPI: 1184930117
Entity Type: Individual

Specialty information:

PrimaryCodeCategory/DescriptionStateLicense Number
Y1041C0700XBehavioral Health & Social Service Providers
Social Worker
Clinical
COCSW-1510
N1041S0200XBehavioral Health & Social Service Providers
Social Worker
CO0473664

Legacy codes, insurance codes and state license numbers:

IssuerNumberStateType
VALUE OPTIONS, MEDICAID701760CO01
49330888CO05




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