Individual
THERESA BEARY-TAYLOR
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
2238 1ST ST, SLIDELL, LA 70458-3606
(985) 690-6622
(985) 690-6662
Mailing address
2238 1ST ST, SLIDELL, LA 70458-3606
(985) 690-6622
(985) 690-6662
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
4547
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
202977783
TAX ID #
LA
Enumeration date
11/23/2010
Last updated
11/23/2010
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