Vickie Y Beard
Individual provider Active NPI Counselor · Macomb, IL
NPI 1578853164 · NPPES record last updated Nov 30, 2011
Key facts
- NPI
- 1578853164
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Counselor 101Y00000X
- Practice address
- 103 S Johnson St
Macomb, IL 61455-2134 - Phone
- (309) 833-2008
- NPI assigned
- Apr 15, 2011
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 178.007584 | IL | MD | Professional Counselor |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Synago, LLC | Counselor | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Professional Counselor | 101YP2500X | 178.007584 | IL | |
| Addiction (Substance Use Disorder) Counselor | 101YA0400X | |||
| Counselor | 101Y00000X | Yes | ||
| Mental Health Counselor | 101YM0800X |
Addresses
Primary practice location
103 S Johnson St
Macomb, IL 61455-2134
Mailing address
103 S Johnson St
Macomb, IL 61455-2134
Phone (309) 833-2008
Other providers in Macomb, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Nov 30, 2011. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.