Provider Demographics
NPI:1962906388
Name:BEVERLY, ASHLEY S (LMSW)
Entity type:Individual
Prefix:MS
First Name:ASHLEY
Middle Name:S
Last Name:BEVERLY
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1989 OBSIDIAN TRAIL
Mailing Address - Street 2:
Mailing Address - City:HEARTLAND
Mailing Address - State:TX
Mailing Address - Zip Code:75126-8895
Mailing Address - Country:US
Mailing Address - Phone:817-703-5832
Mailing Address - Fax:
Practice Address - Street 1:4500 S LANCASTER RD
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75216-7167
Practice Address - Country:US
Practice Address - Phone:214-742-8387
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-20
Last Update Date:2022-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX64501104100000X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker