MEDICARE: LORI LEE BEARD LMHC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor	MH11799	FL

General Provider Information

NPI Number	:	1073957841
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LORI LEE BEARD LMHC

Provider Business Mailing Address
First Line	:	1544 RUSKIN LN
Second Line	:
City	:	FERNANDINA BEACH
State	:	FL
Zip	:	32034-1958
Country	:	US
Telephone Number	:	904-405-9469
Fax Number	:

Provider Business Practice Location Address
First Line	:	2720 PARK ST
Second Line	:	STE 216
City	:	JACKSONVILLE
State	:	FL
Zip	:	32205-7645
Country	:	US
Telephone Number	:	904-405-9469
Fax Number	:	855-261-3372

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/24/2013
Last Update Date	:	01/16/2016

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