MEDICARE: KIMBERLY LYNNE BEATTY LCSW

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	104100000X	Social Worker

General Provider Information

NPI Number	:	1184947921
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KIMBERLY LYNNE BEATTY LCSW

Provider Business Mailing Address
First Line	:	302 E MAIN ST
Second Line	:	STE 210
City	:	LEAGUE CITY
State	:	TX
Zip	:	77573-3743
Country	:	US
Telephone Number	:	832-769-6703
Fax Number	:

Provider Business Practice Location Address
First Line	:	302 E MAIN ST
Second Line	:	STE 210
City	:	LEAGUE CITY
State	:	TX
Zip	:	77573-3743
Country	:	US
Telephone Number	:	832-769-6703
Fax Number	:

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

Provider Enumeration Date	:	03/08/2010
Last Update Date	:	02/17/2019

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