Provider Demographics
NPI:1144522954
Name:ANTOINE, BEVERLEY M (PHD/PSYD)
Entity type:Individual
Prefix:DR
First Name:BEVERLEY
Middle Name:M
Last Name:ANTOINE
Suffix:
Gender:F
Credentials:PHD/PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2980 SUN LAKE DR
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89128-7713
Mailing Address - Country:US
Mailing Address - Phone:702-631-1385
Mailing Address - Fax:702-631-1385
Practice Address - Street 1:2980 SUN LAKE DR
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89128-7713
Practice Address - Country:US
Practice Address - Phone:702-631-1385
Practice Address - Fax:702-631-1385
Is Sole Proprietor?:No
Enumeration Date:2010-11-30
Last Update Date:2018-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA25297106H00000X
NV0543106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist