Provider Demographics
NPI:1538378237
Name:CLAGG, BEVERLY (LMFT)
Entity type:Individual
Prefix:
First Name:BEVERLY
Middle Name:
Last Name:CLAGG
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:750 W LINCOLN TRAIL BLVD
Mailing Address - Street 2:SUITE 103
Mailing Address - City:RADCLIFF
Mailing Address - State:KY
Mailing Address - Zip Code:40160-2604
Mailing Address - Country:US
Mailing Address - Phone:270-351-8976
Mailing Address - Fax:270-351-8980
Practice Address - Street 1:750 W LINCOLN TRAIL BLVD
Practice Address - Street 2:SUITE 103
Practice Address - City:RADCLIFF
Practice Address - State:KY
Practice Address - Zip Code:40160-2604
Practice Address - Country:US
Practice Address - Phone:270-351-8976
Practice Address - Fax:270-351-8980
Is Sole Proprietor?:No
Enumeration Date:2007-05-21
Last Update Date:2008-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYKY0335106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist