1043627383 NPI number — MICHAEL BECKER PHD, LPC

Table of content: MICHAEL BECKER PHD, LPC (NPI 1043627383)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1043627383 NPI number — MICHAEL BECKER PHD, LPC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BECKER
Provider First Name:
MICHAEL
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
PHD, LPC
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1043627383
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/23/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
70 SW CENTURY DR STE 100-160
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BEND
Provider Business Mailing Address State Name:
OR
Provider Business Mailing Address Postal Code:
97702-3557
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
541-249-9539
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
361 NE FRANKLIN AVE
Provider Second Line Business Practice Location Address:
BLDG E STE 11
Provider Business Practice Location Address City Name:
BEND
Provider Business Practice Location Address State Name:
OR
Provider Business Practice Location Address Postal Code:
97701
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
541-633-0997
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/18/2014

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101YM0800X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 283234 , issued by the state of ( OR ) . This identifiers is of the category "MEDICAID".




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