MEDICARE: MRS. BEVERLY A HIME M.A., 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	11851	TX

General Provider Information

NPI Number	:	1841281656
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. BEVERLY A HIME M.A., LPC

Provider Business Mailing Address
First Line	:	1001 PAT BOOKER RD
Second Line	:	SUITE 208
City	:	UNIVERSAL CITY
State	:	TX
Zip	:	78148-4154
Country	:	US
Telephone Number	:	210-723-8309
Fax Number	:	830-980-4463

Provider Business Practice Location Address
First Line	:	1001 PAT BOOKER RD
Second Line	:	SUITE 208
City	:	UNIVERSAL CITY
State	:	TX
Zip	:	78148-4154
Country	:	US
Telephone Number	:	210-723-8309
Fax Number	:	830-980-4463

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

Provider Enumeration Date	:	11/01/2005
Last Update Date	:	07/08/2007

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