Healthcare Provider Details

I. General information

NPI: 1487762134
Provider Name (Legal Business Name): LYNN KELLY BECK MS, LMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/25/2006
Last Update Date: 02/01/2025
Certification Date: 02/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

907 MARIOTT DR. SUITE 2022
FORT WALTON BEACH FL
32547
US

IV. Provider business mailing address

907 MAR WALT DR STE 2022
FORT WALTON BEACH FL
32547-6631
US

V. Phone/Fax

Practice location:
  • Phone: 850-243-0095
  • Fax: 850-374-3192
Mailing address:
  • Phone: 850-243-0095
  • Fax: 850-374-3192

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMH5763
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: