Healthcare Provider Details

I. General information

NPI: 1962894881
Provider Name (Legal Business Name): STEPHANI BECKETT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: STEPHANI BECKETT PLPC

II. Dates (important events)

Enumeration Date: 03/02/2015
Last Update Date: 03/02/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 W 6TH ST
APPLETON CITY MO
64724-1434
US

IV. Provider business mailing address

500 W 6TH ST
APPLETON CITY MO
64724-1434
US

V. Phone/Fax

Practice location:
  • Phone: 417-448-4462
  • Fax:
Mailing address:
  • Phone: 417-448-4462
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number2015006039
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: