Provider Demographics
NPI:1972805968
Name:BEVERLY COUNSELING ASSOCIATES
Entity type:Organization
Organization Name:BEVERLY COUNSELING ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MFT/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BEVERLY
Authorized Official - Middle Name:JANE
Authorized Official - Last Name:RATTRAY
Authorized Official - Suffix:
Authorized Official - Credentials:MFT
Authorized Official - Phone:951-461-0777
Mailing Address - Street 1:41197 GOLDEN GATE CIR
Mailing Address - Street 2:SUITE 201
Mailing Address - City:MURRIETA
Mailing Address - State:CA
Mailing Address - Zip Code:92562-6997
Mailing Address - Country:US
Mailing Address - Phone:951-461-0777
Mailing Address - Fax:951-461-0778
Practice Address - Street 1:41197 GOLDEN GATE CIR
Practice Address - Street 2:SUITE 201
Practice Address - City:MURRIETA
Practice Address - State:CA
Practice Address - Zip Code:92562-6997
Practice Address - Country:US
Practice Address - Phone:951-461-0777
Practice Address - Fax:951-461-0778
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BEVERLY COUNSELING ASSCIATES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-11-23
Last Update Date:2010-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MFC39317106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty