Timothy Ray Beverly, CDCA

Primary specialty

Addiction (Substance Use Disorder) CounselorTaxonomy code 101YA0400X

License

LCDCII.161829 Issued in OH

Practice address

302 W Main St
Fairborn, OH 45324-5037

Phone

(937) 281-4673

NPI assigned

Jul 10, 2018

Last updated

Jan 25, 2024By the provider in NPPES

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Decoach Team LLC

  dba DeCoach Rehabilitation Centre

  • Substance Use Disorder Rehabilitation Clinic/Center
  • Cincinnati, OH
  • NPI 1366992224
  NPD
• Decoach Team LLC

  dba DeCoach Rehabilitation Centre

  • Adult Mental Health Clinic/Center
  • Cincinnati, OH
  • NPI 1578037552
  NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1531180800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1706140800000",
    "number": "1194211409",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "100 CROWNE POINT PLACE",
            "city": "CINCINNATI",
            "state": "OH",
            "postal_code": "452415427",
            "telephone_number": "513-743-7628"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "302 W MAIN ST",
            "city": "FAIRBORN",
            "state": "OH",
            "postal_code": "453245037",
            "telephone_number": "937-281-4673"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BEVERLY",
        "first_name": "TIMOTHY",
        "middle_name": "RAY",
        "name_prefix": "Mr.",
        "credential": "CDCA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2018-07-10",
        "last_updated": "2024-01-25",
        "certification_date": "2024-01-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "OH",
            "license": "070488",
            "primary": false
        },
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "OH",
            "license": "LCDCII.161829",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Cheyanna Elizabeth Berelsman, BSSW, LSW
• Shane Richard Berger
• Michele Berning
• Linda Best, CDCA
• Lauren Beverly
• Gabrielle Bianco
• Hailey Bidwell
• Eugenia Dionne Black
• Hillary Blagg
• Laverna Blas

• Addiction (Substance Use Disorder) Counselor in Fairborn, OH
• Providers in Fairborn, OH by specialty
• Addiction (Substance Use Disorder) Counselor in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 25, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.