Provider Demographics
NPI:1295212660
Name:BEARD, NICHOLAS (LPC)
Entity type:Individual
Prefix:
First Name:NICHOLAS
Middle Name:
Last Name:BEARD
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1940 MESQUITE AVE STE O
Mailing Address - Street 2:
Mailing Address - City:LAKE HAVASU CITY
Mailing Address - State:AZ
Mailing Address - Zip Code:86403-6123
Mailing Address - Country:US
Mailing Address - Phone:928-732-0470
Mailing Address - Fax:928-756-0580
Practice Address - Street 1:1940 MESQUITE AVE STE O
Practice Address - Street 2:
Practice Address - City:LAKE HAVASU CITY
Practice Address - State:AZ
Practice Address - Zip Code:86403-6123
Practice Address - Country:US
Practice Address - Phone:928-732-0470
Practice Address - Fax:928-756-0580
Is Sole Proprietor?:No
Enumeration Date:2018-07-27
Last Update Date:2025-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX89525101YP2500X
AZLPC-17438101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional