Healthcare Provider Details

I. General information

NPI: 1912005455
Provider Name (Legal Business Name): JOSEPH GEORGE BECKETT LCPC, LSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/20/2006
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7905 N MEADOWLARK WAY SUITE C
COEUR D ALENE ID
83815-5041
US

IV. Provider business mailing address

7905 N MEADOWLARK WAY SUITE C
COEUR D ALENE ID
83815-5041
US

V. Phone/Fax

Practice location:
  • Phone: 208-762-3979
  • Fax: 208-762-4419
Mailing address:
  • Phone: 208-762-3979
  • Fax: 208-762-4419

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberLCPC-3435
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: