Provider Demographics
NPI:1548277213
Name:BEAVERS, VICKIE ANNETTE (LPC, LMFT)
Entity type:Individual
Prefix:
First Name:VICKIE
Middle Name:ANNETTE
Last Name:BEAVERS
Suffix:
Gender:F
Credentials:LPC, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7537 MEADOWBROOK DR
Mailing Address - Street 2:
Mailing Address - City:WATAUGA
Mailing Address - State:TX
Mailing Address - Zip Code:76148-1727
Mailing Address - Country:US
Mailing Address - Phone:817-485-8321
Mailing Address - Fax:
Practice Address - Street 1:200 N RUFE SNOW DR
Practice Address - Street 2:SUITE 102
Practice Address - City:KELLER
Practice Address - State:TX
Practice Address - Zip Code:76248-4226
Practice Address - Country:US
Practice Address - Phone:817-485-8321
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-02
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX18117101YP2500X
TX005077-005716106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Not Answered106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN10011613Medicaid
TX6518LCOtherBCBS