MEDICARE: NICHOLAS BEARD LPC

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	101YP2500X	Professional Counselor	89525	TX
2	101Y00000X	Counselor	LPC-17438	AZ

General Provider Information

NPI Number	:	1295212660
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NICHOLAS BEARD LPC

Provider Business Mailing Address
First Line	:	1940 MESQUITE AVE STE O
Second Line	:
City	:	LAKE HAVASU CITY
State	:	AZ
Zip	:	86403-6123
Country	:	US
Telephone Number	:	928-732-0470
Fax Number	:	928-756-0580

Provider Business Practice Location Address
First Line	:	1940 MESQUITE AVE STE O
Second Line	:
City	:	LAKE HAVASU CITY
State	:	AZ
Zip	:	86403-6123
Country	:	US
Telephone Number	:	928-732-0470
Fax Number	:	928-756-0580

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

Provider Enumeration Date	:	07/27/2018
Last Update Date	:	06/27/2025

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