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NPI Code Detail

MEDICARE: MR. MICHAEL COREY BEARDEN LPC

MEDICARE:  MR. MICHAEL COREY BEARDEN  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
1101YM0800XMental Health Counselor66256TX
2101YP1600XPastoral Counselor66256TX
3106H00000XMarriage & Family Therapist66256TX

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1437450780
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. MICHAEL COREY BEARDEN LPC
Provider Business Mailing Address
First Line : 2209 EDWIN ST
Second Line :
City : FORT WORTH
State : TX
Zip : 76110-1215
Country : US
Telephone Number : 817-897-7247
Fax Number : 817-549-0293
Provider Business Practice Location Address
First Line : 1810 8TH AVE
Second Line : SUITE A
City : FORT WORTH
State : TX
Zip : 76110-1352
Country : US
Telephone Number : 817-897-7247
Fax Number : 817-549-0293
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/03/2010
Last Update Date : 10/25/2013

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Directions to “ MR. MICHAEL COREY BEARDEN LPC” Practice Location

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