Healthcare Provider Details

I. General information

NPI: 1013748748
Provider Name (Legal Business Name): ANDREA BEARDEN, LCSW
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/13/2024
Last Update Date: 01/04/2025
Certification Date: 01/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 W MAIN ST STE 1B
MEDFORD OR
97501-2744
US

IV. Provider business mailing address

3879 CREEK MONT DR
MEDFORD OR
97504-8923
US

V. Phone/Fax

Practice location:
  • Phone: 541-499-5753
  • Fax:
Mailing address:
  • Phone: 541-499-5753
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: ANDREA BEARDEN
Title or Position: OWNER
Credential: LCSW
Phone: 541-499-5753