Provider Demographics
NPI:1417618455
Name:BEARDEN, KATIE LAUREN (ALC)
Entity Type:Individual
Prefix:MRS
First Name:KATIE
Middle Name:LAUREN
Last Name:BEARDEN
Suffix:
Gender:F
Credentials:ALC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4731 HOLLOW LN
Mailing Address - Street 2:
Mailing Address - City:HELENA
Mailing Address - State:AL
Mailing Address - Zip Code:35080-3434
Mailing Address - Country:US
Mailing Address - Phone:205-585-9573
Mailing Address - Fax:205-318-2714
Practice Address - Street 1:1920 VALLEYDALE RD STE 274
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35244-1749
Practice Address - Country:US
Practice Address - Phone:205-578-8536
Practice Address - Fax:205-318-2714
Is Sole Proprietor?:No
Enumeration Date:2022-01-03
Last Update Date:2022-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALC3401A101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health