Provider Demographics
NPI:1891466249
Name:BEARD, KAMI SHEREE (CRM, CADC 1)
Entity Type:Individual
Prefix:
First Name:KAMI
Middle Name:SHEREE
Last Name:BEARD
Suffix:
Gender:F
Credentials:CRM, CADC 1
Other - Prefix:
Other - First Name:KAMI
Other - Middle Name:SHEREE
Other - Last Name:WILLSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:138 NE CONIFER BLVD APT 6
Mailing Address - Street 2:
Mailing Address - City:CORVALLIS
Mailing Address - State:OR
Mailing Address - Zip Code:97330-7004
Mailing Address - Country:US
Mailing Address - Phone:541-230-8755
Mailing Address - Fax:
Practice Address - Street 1:231 LYON ST SE
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:OR
Practice Address - Zip Code:97321-2707
Practice Address - Country:US
Practice Address - Phone:541-791-3411
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-24
Last Update Date:2021-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR21-08-10216101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)