Healthcare Provider Details

I. General information

NPI: 1386185742
Provider Name (Legal Business Name): JASON BECKER LMFT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/17/2017
Last Update Date: 03/17/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14300 NICOLLET CT STE 130
BURNSVILLE MN
55306-4501
US

IV. Provider business mailing address

2550 UNIVERSITY AVE W 4STE 435 S
SAINT PAUL MN
55114-1052
US

V. Phone/Fax

Practice location:
  • Phone: 952-435-8814
  • Fax: 952-435-7705
Mailing address:
  • Phone: 651-647-1900
  • Fax: 651-647-1861

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number2989
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: