Healthcare Provider Details

I. General information

NPI: 1285890541
Provider Name (Legal Business Name): ALAN MARK BECKER M.A., CCC-A
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/05/2008
Last Update Date: 08/05/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2601 W MAIN ST STE C
TUPELO MS
38801-3034
US

IV. Provider business mailing address

2601 W MAIN ST STE C
TUPELO MS
38801-3034
US

V. Phone/Fax

Practice location:
  • Phone: 662-842-6325
  • Fax: 662-842-6340
Mailing address:
  • Phone: 662-842-6325
  • Fax: 662-842-6340

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237600000X
TaxonomyAudiologist-Hearing Aid Fitter
License NumberA0668
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: