Active NPI
Brenda Beverly, CADC
- Addiction (Substance Use Disorder) Counselor
- Jackson, MI
National Provider Identifier
1043608680
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Addiction (Substance Use Disorder) Counselor
- License
- 2-00945
- Practice address
- 1190 West
1190 West Suite 812
Jackson, MI 49202 - Phone
- (517) 513-3657
- Fax
- (517) 513-3693
- NPI assigned
- Jan 6, 2015
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Addiction (Substance Use Disorder) Counselor | 101YA0400X | 2-00945 | MI | Primary |
Addresses
Primary practice location
1190 West
1190 West Suite 812
Jackson, MI 49202
Mailing address
3817 Lone Pine Dr Apt 2
Holt, MI 48842-8800
Phone (989) 233-1020
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2-00945 | MI | MD | Addiction (Substance Use Disorder) Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1420502400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1420502400000",
"number": "1043608680",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3817 LONE PINE DR APT 2",
"city": "HOLT",
"state": "MI",
"postal_code": "488428800",
"telephone_number": "989-233-1020"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1190 WEST",
"address_2": "1190 WEST SUITE 812",
"city": "JACKSON",
"state": "MI",
"postal_code": "49202",
"telephone_number": "517-513-3657",
"fax_number": "517-513-3693"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BEVERLY",
"first_name": "BRENDA",
"credential": "CADC",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2015-01-06",
"last_updated": "2015-01-06",
"status": "A"
},
"taxonomies": [
{
"code": "101YA0400X",
"taxonomy_group": "",
"desc": "Counselor, Addiction (Substance Use Disorder)",
"state": "MI",
"license": "2-00945",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Jackson, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 6, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.