Healthcare Provider Details

I. General information

NPI: 1629686498
Provider Name (Legal Business Name): WENDY BECKER PSYCHOTHERAPY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/17/2020
Last Update Date: 12/16/2025
Certification Date: 12/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

515 EDWARDSVILLE RD UNIT 90
TROY IL
62294-7003
US

IV. Provider business mailing address

515 EDWARDSVILLE RD UNIT 90
TROY IL
62294-7003
US

V. Phone/Fax

Practice location:
  • Phone: 253-432-8389
  • Fax:
Mailing address:
  • Phone: 253-432-8389
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: WENDY BECKER
Title or Position: OWNER
Credential:
Phone: 253-432-8389