Healthcare Provider Details

I. General information

NPI: 1194207167
Provider Name (Legal Business Name): THERESA BECKLES MSW, LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/05/2018
Last Update Date: 08/19/2022
Certification Date: 08/17/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11358 VAN CLEVE AVE
SAINT LOUIS MO
63114-1131
US

IV. Provider business mailing address

11358 VAN CLEVE AVE
SAINT LOUIS MO
63114-1131
US

V. Phone/Fax

Practice location:
  • Phone: 314-968-2350
  • Fax:
Mailing address:
  • Phone: 314-968-2350
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number2020037926
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number2018020032
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: