Provider Demographics
NPI:1255971008
Name:BEARD, AUDREY E (LMHC)
Entity type:Individual
Prefix:
First Name:AUDREY
Middle Name:E
Last Name:BEARD
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:AUDREY
Other - Middle Name:E
Other - Last Name:MOORE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LMHC
Mailing Address - Street 1:482 S LANDMARK AVE
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGTON
Mailing Address - State:IN
Mailing Address - Zip Code:47403-5000
Mailing Address - Country:US
Mailing Address - Phone:812-333-8474
Mailing Address - Fax:
Practice Address - Street 1:482 S LANDMARK AVE
Practice Address - Street 2:
Practice Address - City:BLOOMINGTON
Practice Address - State:IN
Practice Address - Zip Code:47403-5000
Practice Address - Country:US
Practice Address - Phone:812-333-8474
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-09
Last Update Date:2023-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN39003690A101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health