Healthcare Provider Details

I. General information

NPI: 1881607620
Provider Name (Legal Business Name): ROBERT ALAN BECKER PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/14/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

763 S NEW BALLAS RD SUITE 302
SAINT LOUIS MO
63141-8704
US

IV. Provider business mailing address

763 S NEW BALLAS RD SUITE 302
SAINT LOUIS MO
63141-8704
US

V. Phone/Fax

Practice location:
  • Phone: 314-994-7009
  • Fax: 314-692-7929
Mailing address:
  • Phone: 314-994-7009
  • Fax: 314-692-7929

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberPY 01039
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: