Healthcare Provider Details

I. General information

NPI: 1871643767
Provider Name (Legal Business Name): BEVERLY H WORLEY MA,LPC,LMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MS. BEVERLY JUNE WORLEY

II. Dates (important events)

Enumeration Date: 01/11/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5608 MALVEY AVE SUITE 306
FORT WORTH TX
76107-5100
US

IV. Provider business mailing address

5608 MALVEY AVE SUITE 306
FORT WORTH TX
76107-5100
US

V. Phone/Fax

Practice location:
  • Phone: 817-996-8890
  • Fax: 817-737-5757
Mailing address:
  • Phone: 817-996-8890
  • Fax: 817-737-5757

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number09390
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: