MEDICARE: TOYAH BEVERLY MA, 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	68460	TX
2	106H00000X	Marriage & Family Therapist	201779	TX

General Provider Information

NPI Number	:	1609206382
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TOYAH BEVERLY MA, LPC,LMFT

Provider Business Mailing Address
First Line	:	3005 S LAMAR BLVD
Second Line	:	STE-D 109 #318
City	:	AUSTIN
State	:	TX
Zip	:	78704-8864
Country	:	US
Telephone Number	:	512-721-0417
Fax Number	:

Provider Business Practice Location Address
First Line	:	3005 S LAMAR BLVD
Second Line	:	STE-D 109 #318
City	:	AUSTIN
State	:	TX
Zip	:	78704-8864
Country	:	US
Telephone Number	:	512-721-0417
Fax Number	:

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

Provider Enumeration Date	:	11/18/2013
Last Update Date	:	08/11/2016

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