Provider Demographics
NPI:1427177591
Name:WOMACK, BEVERLY SUE (LCSW, LMFT, LCDC)
Entity type:Individual
Prefix:MRS
First Name:BEVERLY
Middle Name:SUE
Last Name:WOMACK
Suffix:
Gender:F
Credentials:LCSW, LMFT, LCDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:514 E COMMERCE ST
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:75766-4910
Mailing Address - Country:US
Mailing Address - Phone:903-586-1428
Mailing Address - Fax:903-586-0929
Practice Address - Street 1:514 E COMMERCE ST
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:TX
Practice Address - Zip Code:75766-4910
Practice Address - Country:US
Practice Address - Phone:903-586-1428
Practice Address - Fax:903-586-0929
Is Sole Proprietor?:No
Enumeration Date:2007-03-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX409101YA0400X
TX062151041C0700X
TX4307106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Not Answered1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Not Answered106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist