Provider Demographics
NPI:1861558819
Name:NELSON, BEVERLY YVONNE
Entity type:Individual
Prefix:MRS
First Name:BEVERLY
Middle Name:YVONNE
Last Name:NELSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:193 MCCLANAHAN ROAD
Mailing Address - Street 2:
Mailing Address - City:LIBERTY
Mailing Address - State:SC
Mailing Address - Zip Code:29657
Mailing Address - Country:US
Mailing Address - Phone:864-294-5155
Mailing Address - Fax:
Practice Address - Street 1:193 MCCLANAHAN RD
Practice Address - Street 2:
Practice Address - City:LIBERTY
Practice Address - State:SC
Practice Address - Zip Code:29657-8931
Practice Address - Country:US
Practice Address - Phone:864-294-5155
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC2601106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist