Basic Information
| Provider Information | |||||||||
| NPI: | 1740249549 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HILL | ||||||||
| FirstName: | BEVERLY | ||||||||
| MiddleName: | CAGLE | ||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | RN, LCSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 502 MERRIFIELD DR | ||||||||
| Address2: | |||||||||
| City: | HEWITT | ||||||||
| State: | TX | ||||||||
| PostalCode: | 766434030 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2548579975 | ||||||||
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| Practice Location | |||||||||
| Address1: | 304 S 22ND ST | ||||||||
| Address2: | |||||||||
| City: | TEMPLE | ||||||||
| State: | TX | ||||||||
| PostalCode: | 765014726 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2542987000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 03/21/2006 | ||||||||
| LastUpdateDate: | 01/07/2010 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | 27275 | TX | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
ID Information
| ID | Type | State | Issuer | Description | 145510702 | 05 | TX | MEDICAID |