Healthcare Provider Details

I. General information

NPI: 1760546857
Provider Name (Legal Business Name): SARAH K BECK CDP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/21/2006
Last Update Date: 07/31/2024
Certification Date: 07/31/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7477 MISSION BLVD
JURUPA VALLEY CA
92509-2400
US

IV. Provider business mailing address

PO BOX 82819
PORTLAND OR
97282-0819
US

V. Phone/Fax

Practice location:
  • Phone: 951-441-0888
  • Fax:
Mailing address:
  • Phone: 503-233-5405
  • Fax: 503-233-2696

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberCP00005107
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number118798
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: