Provider Demographics
NPI:1730391749
Name:BEARD, KEITH W (PSYD)
Entity type:Individual
Prefix:DR
First Name:KEITH
Middle Name:W
Last Name:BEARD
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 JOHN MARSHALL DR
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON
Mailing Address - State:WV
Mailing Address - Zip Code:25755-0002
Mailing Address - Country:US
Mailing Address - Phone:304-696-2781
Mailing Address - Fax:
Practice Address - Street 1:ONE JOHN MARSHALL DRIVE
Practice Address - Street 2:MARSHALL UNIVERSITY - PSYCHOLOGY
Practice Address - City:HUNTINGTON
Practice Address - State:WV
Practice Address - Zip Code:25755-2672
Practice Address - Country:US
Practice Address - Phone:304-696-2781
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-03
Last Update Date:2021-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV1620101YP2500X
KY1369103TC0700X
OH7035103TC0700X
KY128980103TC0700X
WV810103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional