MEDICARE: MR. HUBERT JAMES BEVERLY 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	1041C0700X	Clinical Social Worker	25755	TX

General Provider Information

NPI Number	:	1609963032
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. HUBERT JAMES BEVERLY LCSW

Provider Business Mailing Address
First Line	:	328 S BARBARA ST
Second Line	:
City	:	WACO
State	:	TX
Zip	:	76705-1322
Country	:	US
Telephone Number	:	254-799-6981
Fax Number	:	254-771-4246

Provider Business Practice Location Address
First Line	:	1305 S 33RD ST
Second Line	:
City	:	TEMPLE
State	:	TX
Zip	:	76504-6763
Country	:	US
Telephone Number	:	254-771-4246
Fax Number	:	254-771-4246

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

Provider Enumeration Date	:	10/06/2006
Last Update Date	:	07/09/2007

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