MEDICARE: JENNA NICOLE BEEVER LPC

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	101YM0800X	Mental Health Counselor	0701011175	VA

General Provider Information

NPI Number	:	1215680988
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENNA NICOLE BEEVER LPC

Provider Business Mailing Address
First Line	:	30 ZENTRY PL
Second Line	:
City	:	LYNCHBURG
State	:	VA
Zip	:	24502-1245
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	30 ZENTRY PL
Second Line	:
City	:	LYNCHBURG
State	:	VA
Zip	:	24502-1245
Country	:	US
Telephone Number	:	410-200-5520
Fax Number	:

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

Provider Enumeration Date	:	02/01/2022
Last Update Date	:	02/01/2022

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