Provider Demographics
NPI:1508990714
Name:BEARD, JO ELLEN (DR)
Entity Type:Individual
Prefix:
First Name:JO
Middle Name:ELLEN
Last Name:BEARD
Suffix:
Gender:F
Credentials:DR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1221 E 33RD ST STE 100
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74105-2046
Mailing Address - Country:US
Mailing Address - Phone:918-744-7909
Mailing Address - Fax:918-744-7808
Practice Address - Street 1:1221 E 33RD ST STE 100
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74105-2046
Practice Address - Country:US
Practice Address - Phone:918-744-7909
Practice Address - Fax:918-744-7808
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-16
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK271103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100839420AMedicaid