Provider Demographics
NPI:1104387422
Name:BEARD, GINA DENISE
Entity Type:Individual
Prefix:
First Name:GINA
Middle Name:DENISE
Last Name:BEARD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:716 CYPRESS BEND DR
Mailing Address - Street 2:
Mailing Address - City:BOERNE
Mailing Address - State:TX
Mailing Address - Zip Code:78006-7411
Mailing Address - Country:US
Mailing Address - Phone:210-380-7139
Mailing Address - Fax:
Practice Address - Street 1:716 CYPRESS BEND DR
Practice Address - Street 2:
Practice Address - City:BOERNE
Practice Address - State:TX
Practice Address - Zip Code:78006-7411
Practice Address - Country:US
Practice Address - Phone:210-380-7139
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-28
Last Update Date:2019-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool