Provider Demographics
NPI:1073957841
Name:BEARD, LORI LEE (LMHC)
Entity Type:Individual
Prefix:
First Name:LORI
Middle Name:LEE
Last Name:BEARD
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1544 RUSKIN LN
Mailing Address - Street 2:
Mailing Address - City:FERNANDINA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32034-1958
Mailing Address - Country:US
Mailing Address - Phone:904-405-9469
Mailing Address - Fax:
Practice Address - Street 1:2720 PARK ST
Practice Address - Street 2:STE 216
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32205-7645
Practice Address - Country:US
Practice Address - Phone:904-405-9469
Practice Address - Fax:855-261-3372
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-24
Last Update Date:2016-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH11799101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health