Provider Demographics
NPI:1740548189
Name:KINARD, JACQUELINE A (LMSW)
Entity type:Individual
Prefix:MS
First Name:JACQUELINE
Middle Name:A
Last Name:KINARD
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:MS
Other - First Name:JACQUELINE
Other - Middle Name:A
Other - Last Name:BECKHAM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMSW
Mailing Address - Street 1:839 S WESTWOOD
Mailing Address - Street 2:286-B
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85210-3461
Mailing Address - Country:US
Mailing Address - Phone:480-464-5955
Mailing Address - Fax:
Practice Address - Street 1:839 S WESTWOOD
Practice Address - Street 2:286-B
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85210-3461
Practice Address - Country:US
Practice Address - Phone:480-464-5955
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-04-23
Last Update Date:2012-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLMSW 26521041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical