Provider Demographics
NPI:1558809608
Name:BEARD, SHELLYATTA JOHNSON (LCSW 99953)
Entity type:Individual
Prefix:MS
First Name:SHELLYATTA
Middle Name:JOHNSON
Last Name:BEARD
Suffix:
Gender:F
Credentials:LCSW 99953
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7910 S PINEWOOD DR
Mailing Address - Street 2:
Mailing Address - City:PINE BLUFF
Mailing Address - State:AR
Mailing Address - Zip Code:71603-8963
Mailing Address - Country:US
Mailing Address - Phone:530-921-7648
Mailing Address - Fax:
Practice Address - Street 1:4850 UNION AVE
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95124-5156
Practice Address - Country:US
Practice Address - Phone:800-913-2615
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-02-09
Last Update Date:2025-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR10511-C1041C0700X
CA999531041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical