Provider Demographics
NPI:1699110288
Name:BEARD, MICHELLE LYNN (LMSW)
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:LYNN
Last Name:BEARD
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13519 IOWA AVE
Mailing Address - Street 2:
Mailing Address - City:EAGLE
Mailing Address - State:MI
Mailing Address - Zip Code:48822-9557
Mailing Address - Country:US
Mailing Address - Phone:517-894-5989
Mailing Address - Fax:
Practice Address - Street 1:13519 IOWA AVE
Practice Address - Street 2:
Practice Address - City:EAGLE
Practice Address - State:MI
Practice Address - Zip Code:48822-9557
Practice Address - Country:US
Practice Address - Phone:517-894-5989
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-08
Last Update Date:2025-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6802087557104100000X
MI68011149981041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker