Healthcare Provider Details

I. General information

NPI: 1194864140
Provider Name (Legal Business Name): STEPHEN WESLEY BECKER PSY. D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/06/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

424 MAIN ST
HILLSBORO MO
63050
US

IV. Provider business mailing address

2 WOODCHASE DR APT 24
FARMINGTON MO
63640-1428
US

V. Phone/Fax

Practice location:
  • Phone: 636-789-3494
  • Fax: 636-789-3824
Mailing address:
  • Phone: 636-789-3494
  • Fax: 636-789-3824

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TF0200X
TaxonomyForensic Psychologist
License NumberLC0741199
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: