Provider Demographics
NPI:1063716843
Name:BEAVERS, LISA ANN (PHD, LPC,, MHSP)
Entity type:Individual
Prefix:DR
First Name:LISA
Middle Name:ANN
Last Name:BEAVERS
Suffix:
Gender:F
Credentials:PHD, LPC,, MHSP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 543
Mailing Address - Street 2:
Mailing Address - City:BRENTWOOD
Mailing Address - State:TN
Mailing Address - Zip Code:37024-0543
Mailing Address - Country:US
Mailing Address - Phone:615-364-7776
Mailing Address - Fax:
Practice Address - Street 1:1231 A 17TH AVE S.
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37212
Practice Address - Country:US
Practice Address - Phone:615-364-7776
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-07
Last Update Date:2011-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN1792101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional