MEDICARE: VICKIE ANNETTE BEAVERS LPC, LMFT

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	101YP2500X	Professional Counselor	18117	TX
2	106H00000X	Marriage & Family Therapist	005077-005716	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	6518LC	OTHER	TX	BCBS

General Provider Information

NPI Number	:	1548277213
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	VICKIE ANNETTE BEAVERS LPC, LMFT

Provider Business Mailing Address
First Line	:	7537 MEADOWBROOK DR
Second Line	:
City	:	WATAUGA
State	:	TX
Zip	:	76148-1727
Country	:	US
Telephone Number	:	817-485-8321
Fax Number	:

Provider Business Practice Location Address
First Line	:	200 N RUFE SNOW DR
Second Line	:	SUITE 102
City	:	KELLER
State	:	TX
Zip	:	76248-4226
Country	:	US
Telephone Number	:	817-485-8321
Fax Number	:

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

Provider Enumeration Date	:	08/02/2006
Last Update Date	:	09/11/2025

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