Healthcare Provider Details

I. General information

NPI: 1295212660
Provider Name (Legal Business Name): NICHOLAS BEARD LPC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/27/2018
Last Update Date: 02/20/2026
Certification Date: 02/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1940 MESQUITE AVE STE O
LAKE HAVASU CITY AZ
86403-6123
US

IV. Provider business mailing address

1940 MESQUITE AVE STE O
LAKE HAVASU CITY AZ
86403-6123
US

V. Phone/Fax

Practice location:
  • Phone: 928-732-0470
  • Fax: 928-756-0580
Mailing address:
  • Phone: 928-732-0470
  • Fax: 928-756-0580

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberLPC-17438
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number89525
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: