Basic Information
| Provider Information | |||||||||
| NPI: | 1396495339 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BEVENOUR | ||||||||
| FirstName: | PATRICK | ||||||||
| MiddleName: | JUDE | ||||||||
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| Mailing Information | |||||||||
| Address1: | 176 VALLEY RD | ||||||||
| Address2: | |||||||||
| City: | WARMINSTER | ||||||||
| State: | PA | ||||||||
| PostalCode: | 189745603 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2159012515 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1235 PINE ST | ||||||||
| Address2: | |||||||||
| City: | PHILADELPHIA | ||||||||
| State: | PA | ||||||||
| PostalCode: | 191075945 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2157359379 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 03/24/2022 | ||||||||
| LastUpdateDate: | 03/24/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 03/24/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101Y00000X | BH000189 | PA | Y | Behavioral Health & Social Service Providers | Counselor |
No ID Information.