Healthcare Provider Details

I. General information

NPI: 1457768657
Provider Name (Legal Business Name): LYNNE BEALKE LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/20/2014
Last Update Date: 08/04/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 SOVEREIGN CT STE 211
BALLWIN MO
63011-4435
US

IV. Provider business mailing address

301 SOVEREIGN CT
BALLWIN MO
63011-4441
US

V. Phone/Fax

Practice location:
  • Phone: 314-960-2773
  • Fax:
Mailing address:
  • Phone: 314-960-2773
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number2011009309
License Number StateMO

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: