Healthcare Provider Details

I. General information

NPI: 1932386794
Provider Name (Legal Business Name): LYNNE ANNE BECKER PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/23/2008
Last Update Date: 07/14/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2200 TYDD STREET
EUREKA CA
95501-1284
US

IV. Provider business mailing address

670 9TH STREET SUITE 203
ARCATA CA
95521-6249
US

V. Phone/Fax

Practice location:
  • Phone: 707-441-1624
  • Fax: 707-441-1253
Mailing address:
  • Phone: 707-826-8633
  • Fax: 707-826-8638

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TF0200X
TaxonomyForensic Psychologist
License Number19075
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: