Provider Demographics
NPI:1073326633
Name:BEAVOR, ADRIENNE KAYLE (LPC)
Entity type:Individual
Prefix:
First Name:ADRIENNE
Middle Name:KAYLE
Last Name:BEAVOR
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:447 DUDLEYVILLE RD
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62246-3857
Mailing Address - Country:US
Mailing Address - Phone:618-704-8502
Mailing Address - Fax:
Practice Address - Street 1:1520 S 4TH ST
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:IL
Practice Address - Zip Code:62246-2618
Practice Address - Country:US
Practice Address - Phone:618-664-1224
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-01-28
Last Update Date:2025-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ILBEAV-FYJ3P1101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health