MEDICARE: DR. BEVERLEY M ANTOINE PH.D/PSY.D

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106H00000X	Marriage & Family Therapist	25297	CA
2	106H00000X	Marriage & Family Therapist	0543	NV

General Provider Information

NPI Number	:	1144522954
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BEVERLEY M ANTOINE PH.D/PSY.D

Provider Business Mailing Address
First Line	:	2980 SUN LAKE DR
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89128-7713
Country	:	US
Telephone Number	:	702-631-1385
Fax Number	:	702-631-1385

Provider Business Practice Location Address
First Line	:	2980 SUN LAKE DR
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89128-7713
Country	:	US
Telephone Number	:	702-631-1385
Fax Number	:	702-631-1385

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/30/2010
Last Update Date	:	03/19/2018

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