CAQH Data Summary Date 12/30/2019

Beaver, Rebecca Elaine Professional Counselor Last Reattestation Date: 9/9/2019 4:33:59 PM
CAQH Provider ID : 13926766

PREPARE
Provider Type: Professional Counselor Practice Setting: Inpatient/Outpatient or Outpatient Only
Primary Practice State: WV
Other Practice State(s):

PERSONAL INFORMATION
Name
Title(s) : Licensed Professional Counselor (LPC)
First Name : Rebecca Middle Name : Elaine
Last Name : Beaver Suffix :
Have you used other names? No
Home Address
Street 1 : 5 Lower Coach Road Street 2 :
City : Hurricane State : WV
Country : Province :
County : Zip Code : 25526
Mailing Address
Is Mailing address and Home Address No
Same?
Street 1 : 1340 Hal Greer Blvd Street 2 :
City : Huntington State : WV
Country : United States Province :
County : Cabell County Zip Code : 25701
Primary Method of Contact
Primary E-mail Address : rebecca.beaver@chhi.org Personal E-Mail Address :
PMOC CC Email1 : PMOC CC Email2 :
Phone Numbers
Home Phone : 304-562-2418 Personal Cell Phone : 304-972-8144
Personal Fax : (304) 526-2638
Home Phone Unlisted : No
Personal Identification Numbers
Social Security Number : 300-68-5043
Foreign National Identification Number : FNIN Country of Issue :
Do you have a Unique Physicians No
Identification Number (UPIN)?
Do you have an Individual (Type 1) National Yes Individual NPI : 1710439013
Provider Identifier (NPI)?
Demographics
Gender : Female Race/Ethnicity : White/Caucasian
Birth Date : 5/14/1972 Birth City : Gallipolis
Birth State : OH Birth Country : United States
Are you a US Citizen : Yes Citizenship Country : United States
Work Permits and Visas
Work Permit Status :
Visa Type :
Visa Status :
Visa Expiration Date :

Languages
Non-English languages spoken by provider :

PROFESSIONAL IDENTIFICATION NUMBERS

Professional License
License State : WV Do you currently practice in this state? Yes
License Number : 2223 License Type : PC
License Status : Active
Issue Date : 04/22/2016 Expiration Date : 06/30/2020
License Unlimited : Yes
DEA Registration
Do you have a DEA Registration No
Certificate?
Controlled Dangerous Substance (CDS) Registration
Do you have a CDS Registration No
Certificate?
Medicare
Are you a participating Medicare provider? No
Medicaid
Are you a participating Medicaid provider? No
ECFMG
Do you have a Educational Commission for Foreign Medical Graduates (ECFMG) Number? No
USMLE
USMLE No. : Exam Date :

EDUCATION
Graduate Type : US/Canada Graduate
Undergraduate Education
Country : United States State : OH
School : University of Rio Grande Street 1 : 218 North College Avenue
Graduate Type : US/Canada Graduate
Undergraduate Education
Country : United States State : OH
School : University of Rio Grande Street 1 : 218 North College Avenue
Street 2 : City : Rio Grande
Province :
Zip Code : 45674
Phone Number : 740-245-7236 Fax Number :
Degree : Bachelor of Science (BS)
Start Date : 08/1991 End Date : 05/1995
Area of Training / Course of Study / Major : Psychology
Did you complete your Undergraduate Yes Completion Date : 05/14/1995
education at this school?

TRAINING INFORMATION
Internship :
Did you do any internships? Yes
If your Residency information was migrated from UPD to CAQH ProView but appears on the Internship section, use the "Type" field to move data from
the Internship to the Residency section.Select "Residency" from the type list and then click Save & Continue.
Type : Internship
Country : United States State : WV
County :
Institution/Hospital Name : Prestera Affiliated University :
Street1 : 3375 US Route 60 East Street2 :
City : Huntington Province :

Zip Code : 25705 Phone : 800-642-3434

Phone Extension : Fax Number :
Email Address : Start Date : 04/2012
End Date : 08/2012 Type of Program : Other
Department : Counseling
Specialty : Name of Director : Susan Coyer
Current Program Director :
Did you complete (or will you complete Yes Completion Date : 8/01/2012
within the next 90 days) the training
program at this institution?
If your Residency information was migrated from UPD to CAQH ProView but appears on the Internship section, use the "Type" field to move data from
the Internship to the Residency section.Select "Residency" from the type list and then click Save & Continue.
Type : Internship
Country : United States State : WV
County : Cabell County
Institution/Hospital Name : Huntington Treatment Center Affiliated University :
Street1 : 135 4th Avenue Street2 :
City : Huntington Province :
Zip Code : 25701 Phone : 304-525-5691
Phone Extension : Fax Number :
Email Address : Start Date : 10/2012
End Date : 03/2013 Type of Program :
Department : Counseling
Specialty : Name of Director : Wanda Riffe
Current Program Director :
Did you complete (or will you complete Yes Completion Date : 3/01/2013
within the next 90 days) the training
program at this institution?
Cultural Competency Training :
Have you completed a cultural competency training?
Continuing Medical Education(CME) :
Do you have Continuing Medical Education ? No

SPECIALTY INFORMATION
Primary Specialty
Do you have any specialties? Yes
Primary Specialty : Counselor, Addiction (Substance Use
Disorder)
Board Certified? Yes
Name of Certifying Board : Other, Not Listed
Country : United States State : WV
County : Kanawha County
Street 1 : Street 2 : 436 12th Street, Suite C
City : Dunbar Province :
Zip Code : 25064
Initial Certification Date : 11/1/2014 Does your board certification have an Yes
expiration date?
Expiration Date : 9/30/2020 Last Recertification Date : 9/30/2018

Secondary Specialty
Do you have a Secondary Specialty? Yes
Sub/Secondary Specialty : Marriage & Family Therapist
Board Certified? Yes
Name of Certifying Board : Other, Not Listed
Country : Canada State :
County :
Street 1 : Street 2 :
Country : Canada State :
County :
Street 1 : Street 2 :
City : Province :
Zip Code :
Initial Certification Date : 4/3/2019 Does your board certification have an No
expiration date?
Expiration Date : Last Recertification Date :

Additional Specialty
Do you have any Additional Specialties?
Special Experience, Skills and Training
Please select one or more special experience, skills and training that apply from the list below:
Serious Mental Illness, Substance Abuse, Trauma

Other: Marriage and Family Therapy

CERTIFICATION INFORMATION
Do you have Certifications? : Yes
CPR - Cardio-Pulmonary Resuscitation : No
Basic Life Support (BLS) : No
Advanced Cardiac Life Support (ACLS) : No
Advanced Life Support in OB(ALSO) : No
Health Care Provider (CoreC) : No
Advanced Trauma Life Support (ATLS) : No
Neonatal Advanced Life Support (NALS) : No
Neonatal Resuscitation Program (NRP) : No
Pediatric Advanced Life Support (PALS) : No
Other : No
Anesthesia Permit : No
Therapeutics Classification Number
(Optometrists only) :
Professional Association :
Assocation Name : NAADAC
Start Date : 09/2018 End Date : 09/2019
Assocation Name : ICEEFT
Start Date : 03/2019 End Date : 03/2020
Assocation Name :
Start Date : End Date :
Other Interests :

PRACTICE LOCATIONS
General Information :
Office Type : Primary Practice Providers's Start Date : 10/31/2016
Do you practice at this location?: Yes, I practice at this location
Please Explain: I see patients here at least one day per week on a regular basis
Practice Name : Cabell Huntington Hospital Counseling
Center
Street 1 : 517 9TH ST STE 2B
Street 2 : Country : United States
City : HUNTINGTON State : WV
County : Cabell County Province :
Zip Code : 25701-2020 Email Address : rebecca.beaver@chhi.org
Can general correspondence be sent to this Yes Practice Location Website
location?
Mailing Address :
Street1 : 517 9th Street, Suite 2B Street2 :
City : Huntington State : WV
County : Cabell County Province :
Country : United States Zip Code : 25701
Type of Practice : Hospital Based
Specialty : Other, Not Listed
Subspecialty :
Type of Service provided : Specialist
Do you have an organization (Type 2) NPI? : Yes Organization (Type 2) NPI : 1073518007
Group Medicaid Number : Group Medicare Number :
Phone Numbers :
Office Phone Number : 304-526-2049 Phone Extention :
Fax Number : 304-526-2638 Alternate Phone Number :
Back Office Phone Number :
Cell Phone : 304-972-8144
Pager Number : 3045263835
Phone Coverage :
Does this location provide 24hour/7day a Yes
week phone coverage?:
Long Range Pager Number :
Tax Information :
Tax ID : 550675666 Type of Tax ID : Group
Is this the primary Tax ID for this practice Yes
location?
Group Name : Cabell Huntington Hospital
Do you or your business entity own, No Please explain :
operate, have an interest in, or participate
location?
Group Name : Cabell Huntington Hospital
Do you or your business entity own, No Please explain :
operate, have an interest in, or participate
in any medical enterprise or business?
Do you have a financial relationship with a No Please explain :
hospital, clinical lab, nursing home,
pharmacy, radiology lab, emergency room,
or any other medical related organization?
Network Denial :
Have you closed your practice to any plans or programs ?
Do you want to list this site in the directory Yes
:
Office Hours :
Monday
Start Time : 11:00 AM End Time : 7:00 PM
Tuesday
Start Time : 8:00 AM End Time : 5:00 PM
Wednesday
Start Time : 8:00 AM End Time : 5:00 PM
Thursday
Start Time : 8:00 AM End Time : 5:00 PM
Friday
Start Time : 8:00 AM End Time : 4:00 PM
Saturday
Start Time : End Time :
Sunday
Start Time : End Time :
Do you accept new patients into the Yes
practice?
Accept new patients from physician Yes
referral?
Under what circumstances do you accept referrals? (i.e., letter from another physician,
etc.
What questions should we ask a patient, to help determine the appropriateness of the
referral?
Colleagues :
Do you have any Partners/Associate at this No
location ?
Covering Colleagues :
Specialty :
Mid-Level Practitioners :
Do you have any mid-level practitioners at No
this location?
Office Manager or Business Staff Contact :
First Name : Tresa Last Name : Litteral
Middle Name : Marie Suffix :
Phone Number : 304-526-2049 Fax Number : 304-526-2638
E-mail Address : tresa.litteral@chhi.org
Is Office Manager Credentialing Contact : Yes
Billing Contact :
Office Manager & Billing Contact are same No
?
First Name : Tresa Middle Name : Marie
Last Name : Litteral Street 1 : 1340 Hal Greer Blvd
Billing Company Name :
Street 2 : City : Huntington
State: WV Province :
Country : United States Zip Code : 25701
Phone Number : 304-526-2049 Fax Number : 304-526-2638
E-mail Address : tresa.litteral@chhi.org
Payment and Remittance :
Billing department name : Cabell Huntington Hospital Billing Dept Check Payable to : Cabell Huntington Hospital Counseling
Center
Electronic billing capabilities ? Yes
Office Manager & Payee Contact are same Yes
?
First Name : Tresa Middle Name : Marie
Last Name : Litteral Street 1 : 1340 Hal Greer Blvd
Street 2 : City : Huntington

State: WV Province :
Country : United States Zip Code : 25701
Phone Number : 304-526-2049
Fax Number : 304-526-2638 E-mail Address : tresa.litteral@chhi.org
Practice Limitations and Patient Populations :
Gender Limitations : No
Are there any Age Limitations? : Yes
Age Minimum : 13 Age Maximum : 80
Other Limitations :
Accessibility :
Does this office meet ADA accessibility requirements ?
Does this office provide handicapped accessibility ?
Other Limitations :
Accessibility :
Does this office meet ADA accessibility requirements ?
Does this office provide handicapped accessibility ?
Please specify how this location meets handicapped accessibility requirements:
Exterior Building
Interior Building
Wheelchair access to exam room
Exam table/scale/chair
Gurneys & Stretchers
Portable Lifts
Radiologic Equipment
Signage & documents
Parking
Restroom
Please specify other services for the disabled:
Other Disability Services :
Is this office accessible by public transportation ? Yes
Please specify how this office is accessible by public transportation:
Do you accept Workers' Compensation Patients? No
Are staff trained in identification and care of patients with work-related illness/injury and
provide care/services with an active return to work philosophy?
Modified or alternative duty is actively evaluated for each Workers' Compensation No
claimant?
Office will accommodate urgent walk-ins (or non-urgent appointments within 48 hours) to
treat injured or ill workers and facilitate their return to work, if possible
Staff are available and willing to provide compensation representatives information No
regarding a claimant's care.
Services :
Does this location provide any of the following services:
Laboratory Services? : No Accrediting/Certifying Program :
Is the Lab On-site : No
Refererence lab name :
CLIA Certificate Number :
Radiology Services : No
X-Ray Certification Type : EKG Services? No
Care of Minor Lacerations? No Pulmonary Function testing? No
Allergy Injections : No Allergy Skin Testing : No
Office Gynecology? No
Drawing Blood? No
Asthma Treatment? No Age Appropriate Immunizations? No
Flexible Sigmoidoscopy? No Tympanometry/Audiometry Screening ? No
Osteopathic Manipulation? No IV Hydration treatment? No
Cardiac Stress Test? No Physical Therapy? No
Treadmill? No
Is anesthesia administered in your office ? No What class/category of anesthesia is used
?
Anesthesia Administered by First Name : Anesthesia Administered by Last Name :
Other Services :
Non-English language spoken by office
personnel :
Employee Type :
Do you have any interpreters at this
location?

HOSPITAL AFFILIATIONS
General :
Do you have admitting privileges at one or more hospitals? No
Do you have an admitting arrangement where another provider admits for you? No
Do you have any non-admitting hospital affiliations? No

CREDENTIALING INFORMATION
*** THERE IS NO DATA ON RECORD FOR THIS SECTION**

INSURANCE INFORMATION
Are You Covered Under A Professional Liability Insurance Policy? Yes
Policy Number : SIR-2020
Original Effective Date : 10/01/2016
Current Effective Date : 10/01/2019
Current Expiration Date : 10/01/2020
Carrier/Self Insured Name : Cabell Huntington Hospital Self Insurance
Program
Street 1 : 1340 Hal Greer Blvd Street 2 :
City : Huntington Province :
State : WV Country : United States
Zip Code : 25701 Phone Number : 304-526-2057
Phone Extension : Fax Number : 304-526-4016
Type of coverage : Occurrence
Amount of coverage per occurrence : $3,000,000.00 Amount of coverage aggregate : $9,000,000.00
If Umbrella/Excess coverage, amount of $20,000,000.00
coverage :
If you have changed your coverage within the last ten years, did you purchase tail and/or No
nose (prior occurrence/acts) coverage?
coverage :
If you have changed your coverage within the last ten years, did you purchase tail and/or No
nose (prior occurrence/acts) coverage?
Individual Coverage : No
Do you have prior acts coverage ? No
Policy Number : SIR-2017
Original Effective Date : 10/01/2016
Current Effective Date : 10/01/2017
Current Expiration Date : 10/01/2018
Carrier/Self Insured Name : Cabell Huntington Hospital Self Insurance
Program
Street 1 : 1340 Hal Greer Blvd Street 2 :
City : Huntington Province :
State : WV Country : United States

Zip Code : 25701 Phone Number : 304-526-2057

Phone Extension : Fax Number : 304-526-4016
Type of coverage : Occurrence
Amount of coverage per occurrence : $3,000,000.00 Amount of coverage aggregate : $9,000,000.00
If Umbrella/Excess coverage, amount of $20,000,000.00
coverage :
If you have changed your coverage within the last ten years, did you purchase tail and/or No
nose (prior occurrence/acts) coverage?
Individual Coverage : No
Do you have prior acts coverage ? No

WORK HISTORY INFORMATION

Employment Information Record
Practice/Employer Name : Cabell Huntington Hospital Counseling Department : Counseling
Center
Street 1 : 517 9th Street Street 2 :
Country : United States
City : Huntington State :
Province : Zip Code :
Phone Number : 304-526-2049 Phone Extension : 4665
Fax Number : 304-526-2638
Title/Position : Therapist
Contact First Name : Rebecca Contact Last Name : Beaver
Start Date : 10/2016
Is this your current employer? Yes
Practice/Employer Name : Thomas Memorial Hospital Department : Behavioral Health
Street 1 : 4605 MacCorkle Avenue SW Street 2 :
Country : United States
City : Charleston State : WV
Province : Zip Code : 25309
Phone Number : 304-766-3415 Phone Extension :
Fax Number :
Title/Position : Counselor
Contact First Name : Stephanie Contact Last Name : Gustafson
Start Date : 10/2014
Is this your current employer? No
End Date : 10/2016 Reason for departure : better job
Military :
Are you currently on active military duty? No Are you currently in the Reserves or No
National Guard?

REFERENCES INFORMATION
Provider Type : Professional Counselor
First Name : William
Last Name : Welker
Street 1 : Street 2 :
City: Dunbar State :
Province : Zip Code :
Country : United States Email Address :
Phone Number : 304-546-5660
Fax Number :
Title : Counselor
Relationship : coworker

DISCLOSURE INFORMATION
WV :
Practice Disclosure Information :
A. Have any investigations been initiated or are any pending against you by any state licensure board, registration board, or regulatory agency? No
B. Has your license to practice in any state ever been voluntarily or involuntarily relinquished, restricted, denied, reduced, limited, suspended, placed No
on probation, revoked, or subject to any disciplinary action including reprimand?
C. Have you ever been suspended, sanctioned, or otherwise restricted from participating or been the subject of an investigation in any private, federal, No
or state health insurance program (e.g., Medicare, Medicaid)?
D. Has your narcotics (DEA) registration certificate (federal or state) ever been voluntarily or involuntarily relinquished, limited, suspended, not No
renewed, placed on probation, revoked, or challenged?
E. Have you ever been convicted of or plead no contest to any criminal (felony or misdemeanor) charges including a drug or alcohol-related offense or No
motor vehicle offenses, but not including minor traffic or parking violations? Are any such proceedings currently pending?
F. Have you ever had an academic appointment denied, limited, revoked, suspended, reduced, placed on probation, not renewed, or other adverse No
action taken?
motor vehicle offenses, but not including minor traffic or parking violations? Are any such proceedings currently pending?
F. Have you ever had an academic appointment denied, limited, revoked, suspended, reduced, placed on probation, not renewed, or other adverse No
action taken?
G. Have you ever been refused membership on the medical or allied health staff of any hospital or institution or been denied advancement in staff No
status?
H. Has your employment, medical staff status, appointment, reappointment, or clinical privileges, or scope of practice ever been voluntarily or No
involuntarily suspended, restricted, reduced, revoked, denied, relinquished, not been renewed or subjected to probationary conditions or limited at any
hospital, managed care organization or other health care entity?
I. Have you ever been denied membership or renewal, or been reprimanded, censured, suspended, revoked, placed on probation, or otherwise No
sanctioned by any health care organization, including but not limited to, hospitals, HMOs, PPOs, IPAs, PHOs, professional associations or societies,
professional standards review organization or peer review organizations, or any other health care facilities, based on professional competence?
J. Have you ever withdrawn your application for appointment, reappointment or request for clinical privileges or resigned from the medical or allied No
health staff of a hospital, managed care organization, or other health care facility while under investigation or before a decision about your
appointment or reappointment or clinical privileges was rendered by the governing board of any hospital, managed care organization or any other
health care entity?
K. Have you ever been allowed to resign your position or voluntarily relinquish specific clinical privileges rather than face any charge or investigation No
on the part of the medical staff of a hospital, managed care organization, or other health care entity?
L. Are there currently pending adverse actions on your employment, medical staff appointment, reappointment, clinical privileges or scope of practice No
at any hospital, managed care organization, or other health care entity?
M. Has any investigation (other than normal performance improvement reviews) involving your clinical practice, competence or professional conduct No
ever been initiated by any hospital, managed care organization, governmental agency, other health care facility, or branch of the armed forces?
N. Has your request for any specific clinical privileges or scope of practice ever been denied (as a result of disciplinary action) or granted with stated No
limitations or conditions (aside from ordinary initial probationary requirements of proctorship)? Are such proceedings currently pending?
O. Do you have any knowledge of any civil actions pending against you by any hospital, law enforcement agency, professional group or society? No
P. Have you had any charges of unprofessional conduct brought against you? No
Q. Have you had any charges of fraud brought against you? No
R. Have you received any confirmed Quality Control Citations from a Peer Review Organization (PRO) in the last two (2) years? If you answered yes, No
indicate the address of the PRO that cited you, the circumstances of the citation and the number of points you were fined.
Health Status :
A. Are you physically and mentally able to perform all the essential functions or services necessary to exercise the privileges or services applied for No
with or without a reasonable accommodation?
B. Are you able to perform these functions without significant risk of injury to yourself or others? No
C(1). Do you illegally use drugs? No
C(2). Have you used illegal drugs within the last two years? No
D. Do you currently take any medications that may affect your ability to perform the clinical privileges of scope of practice requested completely and No
safely?
Professional Liability Insurance Coverage Disclosure :
A. Has your professional liability insurance coverage ever been restricted, denied or terminated by action of the insurance company? No
B. Has any (current or previous) professional liability insurance carrier excluded any specific procedures or specific area of practice (e.g., obstetrics, No
surgery, etc.) from your coverage?
C. During the time of your professional practice, have you had any professional liability claims, suits, settlements, or judgments filed against you or No
are any currently pending?
D. Have you ever practiced without professional liability coverage? No