Healthcare Provider Details

I. General information

NPI: 1225391055
Provider Name (Legal Business Name): BECKY NAGY PSYD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/18/2012
Last Update Date: 12/22/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

57239 N MAIN ST
THREE RIVERS MI
49093-9419
US

IV. Provider business mailing address

57239 N MAIN ST
THREE RIVERS MI
49093-9419
US

V. Phone/Fax

Practice location:
  • Phone: 269-273-0030
  • Fax:
Mailing address:
  • Phone: 616-235-4800
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number20042382A
License Number StateIN
# 2
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number6301014295
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: