Individual
MR. LARRY BEARDEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.S.
Contact information
Practice address
428 6TH AVE, LEWISTON, ID 83501-2355
(208) 799-6500
(208) 799-6504
Mailing address
428 6TH AVE, LEWISTON, ID 83501-2355
(208) 799-6500
(208) 799-6504
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
LCPC-4986
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1073885349
—
ID
Enumeration date
11/29/2016
Last updated
11/29/2016
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