| Doctor Name: | ALFRED WILLIAM BEVENUE |
| NPI Number: | 1063642080 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | BSW |
| License Number: | |
| Business Practice Address: | 628 E Creek Ave Mcalester, OK - 745016930 |
| Business Phone Number: | 9184236030 |
| Business Fax Number: | 9184213504 |
| Mailing Address: | Po Box 1404, MCALESTER |
| State: | OK |
| Postal Code: | 745021404 |
| Phone Number: | 9184236030 |
| Fax Number: | 9184213504 |
| NPI Enumeration Date: | 07/24/2009 |
| NPI Last Update Date: | 07/24/2009 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YA0400X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Addiction (Substance Use Disorder) |
| Taxonomy Definition: | |