Healthcare Provider Details

I. General information

NPI: 1255971008
Provider Name (Legal Business Name): AUDREY E BEARD LMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: AUDREY E MOORE LMHC

II. Dates (important events)

Enumeration Date: 01/09/2020
Last Update Date: 10/16/2023
Certification Date: 10/16/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

482 S LANDMARK AVE
BLOOMINGTON IN
47403-5000
US

IV. Provider business mailing address

482 S LANDMARK AVE
BLOOMINGTON IN
47403-5000
US

V. Phone/Fax

Practice location:
  • Phone: 812-333-8474
  • Fax:
Mailing address:
  • Phone: 812-333-8474
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number39003690A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: