Provider Demographics
NPI:1164939310
Name:BEARD, GAIL K (MA, LPC)
Entity Type:Individual
Prefix:
First Name:GAIL
Middle Name:K
Last Name:BEARD
Suffix:
Gender:F
Credentials:MA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:141 S REDWOOD LN
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:IL
Mailing Address - Zip Code:62522-2571
Mailing Address - Country:US
Mailing Address - Phone:217-371-1633
Mailing Address - Fax:
Practice Address - Street 1:630 E WASHINGTON ST FL 3
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:IL
Practice Address - Zip Code:62701-1316
Practice Address - Country:US
Practice Address - Phone:217-544-0842
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-01-09
Last Update Date:2018-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL178.005064101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor