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General NPI Number Information
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NPI Number | 1548388143
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Entity Type | Individual
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Provider Name | BEVERLY HANES M.A. MFT
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Gender | Female
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Dates
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Enumeration Date | 03/26/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 1420 E COOLEY DR SUITE 200 S
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City | COLTON
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State | CA
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Zip | 92324-3981
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Country | US
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Telephone | 951-334-3177
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Fax | 909-424-0222
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Provider Business Mailing Address
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Address Line | PO BOX 52974
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City | RIVERSIDE
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State | CA
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Zip | 92517-3974
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Country | US
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Telephone | 951-334-3177
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Fax | 909-424-0222
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | MFC 40326
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License Number State | CA
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