Provider Demographics
NPI:1740096635
Name:BEARD, TY KYLE (LCSW)
Entity type:Individual
Prefix:
First Name:TY
Middle Name:KYLE
Last Name:BEARD
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:850 N MAIN ST # 640
Mailing Address - Street 2:
Mailing Address - City:MILFORD
Mailing Address - State:UT
Mailing Address - Zip Code:84751-7871
Mailing Address - Country:US
Mailing Address - Phone:435-387-2411
Mailing Address - Fax:
Practice Address - Street 1:850 N MAIN ST # 640
Practice Address - Street 2:
Practice Address - City:MILFORD
Practice Address - State:UT
Practice Address - Zip Code:84751-7871
Practice Address - Country:US
Practice Address - Phone:435-387-2411
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-12-05
Last Update Date:2024-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT13397992-35011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical