Provider Demographics
NPI:1447907720
Name:SMITH, BEVERLY GREEN
Entity type:Individual
Prefix:
First Name:BEVERLY
Middle Name:GREEN
Last Name:SMITH
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 1:2427 FACET OAK
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78232-2652
Mailing Address - Country:US
Mailing Address - Phone:210-286-3242
Mailing Address - Fax:
Practice Address - Street 1:2427 FACET OAK
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78232-2652
Practice Address - Country:US
Practice Address - Phone:210-286-3242
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-07
Last Update Date:2022-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst