Provider Demographics
NPI:1457011280
Name:BEARD, TRESA A (TLLP)
Entity Type:Individual
Prefix:
First Name:TRESA
Middle Name:A
Last Name:BEARD
Suffix:
Gender:F
Credentials:TLLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6570 E JK AVE APT D
Mailing Address - Street 2:
Mailing Address - City:KALAMAZOO
Mailing Address - State:MI
Mailing Address - Zip Code:49048-9006
Mailing Address - Country:US
Mailing Address - Phone:240-743-9797
Mailing Address - Fax:
Practice Address - Street 1:3630 CAPITAL AVE SW STE 1
Practice Address - Street 2:
Practice Address - City:BATTLE CREEK
Practice Address - State:MI
Practice Address - Zip Code:49015-7376
Practice Address - Country:US
Practice Address - Phone:692-979-8333
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-12-21
Last Update Date:2022-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health