Provider Demographics
NPI:1356445936
Name:BEARD, ANTOINETTE L (LPCC, CRC)
Entity Type:Individual
Prefix:
First Name:ANTOINETTE
Middle Name:L
Last Name:BEARD
Suffix:
Gender:F
Credentials:LPCC, CRC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:545 N BROAD ST STE 5
Mailing Address - Street 2:
Mailing Address - City:CANFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:44406-9200
Mailing Address - Country:US
Mailing Address - Phone:330-702-0208
Mailing Address - Fax:
Practice Address - Street 1:545 N BROAD ST STE 5
Practice Address - Street 2:
Practice Address - City:CANFIELD
Practice Address - State:OH
Practice Address - Zip Code:44406-9200
Practice Address - Country:US
Practice Address - Phone:330-702-0208
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHE0002270101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional