Provider Demographics
NPI:1750499398
Name:BEARD, CHARLES W (PLMHP)
Entity Type:Individual
Prefix:
First Name:CHARLES
Middle Name:W
Last Name:BEARD
Suffix:
Gender:M
Credentials:PLMHP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:705 W MASONIC ST
Mailing Address - Street 2:APT A
Mailing Address - City:EDINBURG
Mailing Address - State:IL
Mailing Address - Zip Code:62531-9613
Mailing Address - Country:US
Mailing Address - Phone:217-698-7150
Mailing Address - Fax:217-698-7085
Practice Address - Street 1:3000 LENHART RD
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:IL
Practice Address - Zip Code:62711-9203
Practice Address - Country:US
Practice Address - Phone:217-698-7150
Practice Address - Fax:217-698-7085
Is Sole Proprietor?:No
Enumeration Date:2006-08-25
Last Update Date:2016-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE7708101YM0800X
IL180007424101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health