Provider Demographics
NPI:1861890170
Name:BEARD, ANTHONY (LPC-CANIDATE)
Entity type:Individual
Prefix:
First Name:ANTHONY
Middle Name:
Last Name:BEARD
Suffix:
Gender:M
Credentials:LPC-CANIDATE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15055 S BOYD PL
Mailing Address - Street 2:
Mailing Address - City:SAPULPA
Mailing Address - State:OK
Mailing Address - Zip Code:74066-1071
Mailing Address - Country:US
Mailing Address - Phone:918-729-6201
Mailing Address - Fax:
Practice Address - Street 1:1516 S BOSTON AVE STE 1
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74119-4029
Practice Address - Country:US
Practice Address - Phone:918-561-6000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-12-18
Last Update Date:2014-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor