1043282056 NPI number — MS. BEVERLY J. TRICKEY LPC LLC

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1043282056 NPI number — MS. BEVERLY J. TRICKEY LPC LLC

Employer Identification Number (EIN):

Provider Organization Name:

Provider Last Name:

TRICKEY

Provider First Name:

BEVERLY

Provider Middle Name:

J.

Provider Name Prefix Text:

MS.

Provider Name Suffix Text:

Provider Credential Text:

LPC LLC

Provider Gender Code:

F

Provider Other Organization Name:

Provider Other Organization Name Type Code:

Provider Other Last Name:

Provider Other First Name:

Provider Other Middle Name:

Provider Other Name Prefix Text:

Provider Other Name Suffix Text:

Provider Other Credential Text:

Provider Other Last Name Type Code:

NPI Number:

1043282056

Entity Type Code:

Individual

Replacement NPI:

Last Update Date:

03/07/2024

NPI Deactivation Reason Code:

NPI Deactivation Date:

NPI Reactivation Date:

Provider First Line Business Mailing Address:

176 MAPLELEAF CIR

Provider Second Line Business Mailing Address:

Provider Business Mailing Address City Name:

HOT SPRINGS NATIONAL PARK

Provider Business Mailing Address State Name:

AR

Provider Business Mailing Address Postal Code:

71901-3300

Provider Business Mailing Address Country Code:

US

Provider Business Mailing Address Telephone Number:

501-860-1114

Provider Business Mailing Address Fax Number:

501-623-2266

Provider First Line Business Practice Location Address:

100 RIDGEWAY ST STE 1

Provider Second Line Business Practice Location Address:

Provider Business Practice Location Address City Name:

HOT SPRINGS

Provider Business Practice Location Address State Name:

AR

Provider Business Practice Location Address Postal Code:

71901-7155

Provider Business Practice Location Address Country Code:

US

Provider Business Practice Location Address Telephone Number:

501-860-1114

Provider Business Practice Location Address Fax Number:

501-623-2266

Provider Enumeration Date:

02/03/2006

Authorized Official Last Name:

Authorized Official First Name:

Authorized Official Middle Name:

Authorized Official Title or Position:

Authorized Official Telephone Number:

• Taxonomy code: 101YP2500X , with the licence number:  PO304017 , registered in the state of AR ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
• Taxonomy code: 101YP2500X , with the licence number: P0304017 , registered in the state of AR ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

• Identifier: 2159310 . This is a "CIGNA BEHAVIORAL HEALTH" identifier , issued by the state of ( AR ) . This identifiers is of the category "OTHER".
• Identifier: 946145 . This is a "USA MANAGED CARE" identifier , issued by the state of ( AR ) . This identifiers is of the category "OTHER".
• Identifier: 220694 . This is a "COMPSYCH" identifier , issued by the state of ( AR ) . This identifiers is of the category "OTHER".
• Identifier: 60054 . This is a "AETNA" identifier , issued by the state of ( AR ) . This identifiers is of the category "OTHER".
• Identifier: MIS 773923000 . This is a "MAGELLAN" identifier , issued by the state of ( AR ) . This identifiers is of the category "OTHER".
• Identifier: 5X382 . This is a "BLUE CROSS & BLUE SHIELD" identifier , issued by the state of ( AR ) . This identifiers is of the category "OTHER".
• Identifier: 3070018900 . This is a "QUAL-CHOICE" identifier , issued by the state of ( AR ) . This identifiers is of the category "OTHER".
• Identifier: 71-0401764 . This is a "CORPHEALTH" identifier , issued by the state of ( AR ) . This identifiers is of the category "OTHER".
• Identifier: 710401764TRI . This is a "UNITY MANAGED M.H. CO." identifier , issued by the state of ( AR ) . This identifiers is of the category "OTHER".
• Identifier: 297605 . This is a "MHN NETWORK" identifier , issued by the state of ( AR ) . This identifiers is of the category "OTHER".