Provider Demographics
NPI:1417998972
Name:BEARD, JONATHAN PAUL (PHD)
Entity Type:Individual
Prefix:DR
First Name:JONATHAN
Middle Name:PAUL
Last Name:BEARD
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:922 MIDLAND BLVD
Mailing Address - Street 2:
Mailing Address - City:ROYAL OAK
Mailing Address - State:MI
Mailing Address - Zip Code:48073-2886
Mailing Address - Country:US
Mailing Address - Phone:248-588-9058
Mailing Address - Fax:248-588-9058
Practice Address - Street 1:221 S MAIN ST
Practice Address - Street 2:STE 100
Practice Address - City:ROYAL OAK
Practice Address - State:MI
Practice Address - Zip Code:48067-2611
Practice Address - Country:US
Practice Address - Phone:248-545-9200
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301012051103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0N68240Medicare ID - Type Unspecified