Healthcare Provider Details

I. General information

NPI: 1356099477
Provider Name (Legal Business Name): ANSON BECKETT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/17/2022
Last Update Date: 09/17/2026
Certification Date: 09/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3216 BALLARD LN
NEW ALBANY IN
47150-7200
US

IV. Provider business mailing address

3216 BALLARD LN
NEW ALBANY IN
47150-7200
US

V. Phone/Fax

Practice location:
  • Phone: 812-590-2157
  • Fax:
Mailing address:
  • Phone: 812-590-2157
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: