Healthcare Provider Details

I. General information

NPI: 1770714487
Provider Name (Legal Business Name): LYNN M. BEVER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/29/2009
Last Update Date: 01/31/2025
Certification Date: 01/31/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

610 N MAIN ST STE 259
BLACKSBURG VA
24060-3311
US

IV. Provider business mailing address

610 N MAIN ST STE 259
BLACKSBURG VA
24060-3311
US

V. Phone/Fax

Practice location:
  • Phone: 540-239-0598
  • Fax: 540-961-2694
Mailing address:
  • Phone: 540-239-0598
  • Fax: 540-961-2694

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License Number0810003961
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number0810003961
License Number StateVA

VIII. Authorized Official

Name: DR. LYNN M. BEVER
Title or Position: PRESIDENT/CLINICAL PSYCHOLOGIST
Credential: PH.D.
Phone: 540-239-0598