Healthcare Provider Details

I. General information

NPI: 1366945818
Provider Name (Legal Business Name): MS. CHERYL MINDY BECKER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/12/2018
Last Update Date: 09/04/2024
Certification Date: 09/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

170 S OAKLAND AVE
PASADENA CA
91101-2561
US

IV. Provider business mailing address

PO BOX 984
GLENDORA CA
91740-0984
US

V. Phone/Fax

Practice location:
  • Phone: 626-710-2164
  • Fax:
Mailing address:
  • Phone: 626-963-2979
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code221700000X
TaxonomyArt Therapist
License Number91-060
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberMFC25000
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: