Individual
HEATHER L BEAUDRY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PHD
Contact information
Practice address
1907 N ROAN ST STE 207, JOHNSON CITY, TN 37601-3182
(423) 282-0164
Mailing address
1907 N ROAN ST STE 207, JOHNSON CITY, TN 37601-3182
(423) 282-0164
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
TN2735
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
042017
BLUE SHIELD
PA
Enumeration date
11/15/2005
Last updated
04/12/2021
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