Provider Demographics
NPI:1720357346
Name:BEARD, CONNIE (LCDC)
Entity Type:Individual
Prefix:MRS
First Name:CONNIE
Middle Name:
Last Name:BEARD
Suffix:
Gender:F
Credentials:LCDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 6800
Mailing Address - Street 2:
Mailing Address - City:LONGVIEW
Mailing Address - State:TX
Mailing Address - Zip Code:75608-6800
Mailing Address - Country:US
Mailing Address - Phone:903-758-2471
Mailing Address - Fax:903-234-1639
Practice Address - Street 1:1002 TEXAS BLVD
Practice Address - Street 2:SUITE 320
Practice Address - City:TEXARKANA
Practice Address - State:TX
Practice Address - Zip Code:75501-5107
Practice Address - Country:US
Practice Address - Phone:903-831-7585
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-12-28
Last Update Date:2011-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX11185101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)