Healthcare Provider Details

I. General information

NPI: 1265941603
Provider Name (Legal Business Name): BEVERLY WYKLE MSW, LSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: BEVERLY MCCLANAHAN

II. Dates (important events)

Enumeration Date: 09/28/2017
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 S EISENHOWER DR
BECKLEY WV
25801-4929
US

IV. Provider business mailing address

101 S EISENHOWER DR
BECKLEY WV
25801-4929
US

V. Phone/Fax

Practice location:
  • Phone: 304-256-7100
  • Fax: 304-929-5417
Mailing address:
  • Phone: 304-256-7100
  • Fax: 304-929-5417

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberAP00944317
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: