Healthcare Provider Details

I. General information

NPI: 1144285883
Provider Name (Legal Business Name): ELIZABETH ANNE BECK PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 04/18/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

915 N GRAND BLVD A516
SAINT LOUIS MO
63106-1621
US

IV. Provider business mailing address

717 LANGTON DR
CLAYTON MO
63105-2418
US

V. Phone/Fax

Practice location:
  • Phone: 314-289-6371
  • Fax: 314-289-7086
Mailing address:
  • Phone: 314-863-5219
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TH0100X
TaxonomyHealth Service Psychologist
License NumberPY01406
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: