Provider Demographics
NPI:1679942940
Name:BELLARD, BEVERLEY AVRIL (LCPC)
Entity type:Individual
Prefix:
First Name:BEVERLEY
Middle Name:AVRIL
Last Name:BELLARD
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2988 S LOCUST GROVE RD
Mailing Address - Street 2:
Mailing Address - City:KUNA
Mailing Address - State:ID
Mailing Address - Zip Code:83634-2428
Mailing Address - Country:US
Mailing Address - Phone:208-901-8729
Mailing Address - Fax:
Practice Address - Street 1:2988 S LOCUST GROVE RD
Practice Address - Street 2:
Practice Address - City:KUNA
Practice Address - State:ID
Practice Address - Zip Code:83634-2428
Practice Address - Country:US
Practice Address - Phone:208-901-8729
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-09-17
Last Update Date:2024-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLCPC-6814101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor