Provider Demographics
NPI:1811437809
Name:AVERY, BETH
Entity type:Individual
Prefix:
First Name:BETH
Middle Name:
Last Name:AVERY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1200 VALLEY WEST DR STE 306
Mailing Address - Street 2:
Mailing Address - City:WEST DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50266-1904
Mailing Address - Country:US
Mailing Address - Phone:515-267-1340
Mailing Address - Fax:515-267-1355
Practice Address - Street 1:4055 WESTOWN PKWY
Practice Address - Street 2:
Practice Address - City:WEST DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50266-1033
Practice Address - Country:US
Practice Address - Phone:515-224-3344
Practice Address - Fax:515-241-4320
Is Sole Proprietor?:No
Enumeration Date:2017-02-24
Last Update Date:2023-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA007010104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker