Healthcare Provider Details

I. General information

NPI: 1093446742
Provider Name (Legal Business Name): BEVERLY WORD LPC-MHSP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/23/2022
Last Update Date: 06/23/2022
Certification Date: 06/23/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8710 MEADOW GREEN DR
CORDOVA TN
38016-1602
US

IV. Provider business mailing address

8255 MACON RD UNIT 582
CORDOVA TN
38088-0105
US

V. Phone/Fax

Practice location:
  • Phone: 901-209-9455
  • Fax:
Mailing address:
  • Phone: 901-209-9455
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number4516
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLPC010496
License Number StateGA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: