Healthcare Provider Details

I. General information

NPI: 1366454084
Provider Name (Legal Business Name): MADONNA BEARD LPCC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/12/2006
Last Update Date: 04/16/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3020 OLD LEBANON RD
CAMPBELLSVILLE KY
42718-9674
US

IV. Provider business mailing address

130 SOUTHERN SCHOOL RD
SOMERSET KY
42501-3223
US

V. Phone/Fax

Practice location:
  • Phone: 260-465-7424
  • Fax:
Mailing address:
  • Phone: 606-679-4782
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number295
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: