Basic Information
| Provider Information | |||||||||
| NPI: | 1376674481 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | VANN | ||||||||
| FirstName: | BEVERLY | ||||||||
| MiddleName: | ANN | ||||||||
| NamePrefix: | MS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | LASW | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | VANN | ||||||||
| OtherFirstName: | BEVERLY | ||||||||
| OtherMiddleName: | JORDAN | ||||||||
| OtherNamePrefix: | MS. | ||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | LASW | ||||||||
| OtherLastNameType: | 5 | ||||||||
| Mailing Information | |||||||||
| Address1: | 2150 WHITNEY AVE | ||||||||
| Address2: | |||||||||
| City: | MEMPHIS | ||||||||
| State: | TN | ||||||||
| PostalCode: | 381276662 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9013535440 | ||||||||
| FaxNumber: | 9013535464 | ||||||||
| Practice Location | |||||||||
| Address1: | 2150 WHITNEY AVE | ||||||||
| Address2: | |||||||||
| City: | MEMPHIS | ||||||||
| State: | TN | ||||||||
| PostalCode: | 381276662 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9013535440 | ||||||||
| FaxNumber: | 9013535464 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/08/2007 | ||||||||
| LastUpdateDate: | 06/24/2011 | ||||||||
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| NPIReactivationDate: | |||||||||
| ProviderGenderCode: | F | ||||||||
| AuthorizedOfficialLastName: | |||||||||
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| AuthorizedOfficialMiddleName: | |||||||||
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| AuthorizedOfficialTelephone: | |||||||||
| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 104100000X | CMSW0000004197 | TN | N | Behavioral Health & Social Service Providers | Social Worker | 104100000X | LSW0000004197 | TN | N | Behavioral Health & Social Service Providers | Social Worker | 104100000X | ASW0000000363 | TN | Y | Behavioral Health & Social Service Providers | Social Worker |
No ID Information.