Provider Demographics
NPI:1699215798
Name:BARD, STEVEN (LPC)
Entity Type:Individual
Prefix:
First Name:STEVEN
Middle Name:
Last Name:BARD
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4800 COUNTRY WAY E APT 105
Mailing Address - Street 2:
Mailing Address - City:OKEMOS
Mailing Address - State:MI
Mailing Address - Zip Code:48864-1159
Mailing Address - Country:US
Mailing Address - Phone:517-672-2090
Mailing Address - Fax:
Practice Address - Street 1:4800 COUNTRY WAY E APT 105
Practice Address - Street 2:
Practice Address - City:OKEMOS
Practice Address - State:MI
Practice Address - Zip Code:48864-1159
Practice Address - Country:US
Practice Address - Phone:517-672-2090
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-08
Last Update Date:2021-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401015647101YP2500X, 101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional