=====================================================
General NPI Number Information
=====================================================
NPI Number | 1457830648
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | BEVERLY LAUREN MONCRIEF
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/09/2018
-----------------------------------------------------
Last Update Date | 08/09/2018
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3747 HIGHWAY 51 S
-----------------------------------------------------
City | SENATOBIA
-----------------------------------------------------
State | MS
-----------------------------------------------------
Zip | 38668-2942
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 662-612-4549
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1532 HIGHWAY 4 W
-----------------------------------------------------
City | SARAH
-----------------------------------------------------
State | MS
-----------------------------------------------------
Zip | 38665-3529
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 662-612-4549
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1041S0200X
-----------------------------------------------------
Taxonomy Name | School Social Worker
-----------------------------------------------------
License Number | M7435
-----------------------------------------------------
License Number State | MS
-----------------------------------------------------