Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YP2500X | Professional Counselor | 64425 | TX |
NPI | 1003250564 |
---|---|
Provider Name | Mrs. Beverly Ann King |
First Address | San Antonio, TX 78239-2305 |
Second Address | San Antonio, TX 78228-5015 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 26/04/2013 |
Last Update Date | 11/03/2019 |