Healthcare Provider Details

I. General information

NPI: 1043176845
Provider Name (Legal Business Name): ANDREA BECKER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/25/2025
Last Update Date: 12/25/2025
Certification Date: 12/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 S 2ND ST STE 201
BISMARCK ND
58504-5729
US

IV. Provider business mailing address

600 S 2ND ST STE 201
BISMARCK ND
58504-5729
US

V. Phone/Fax

Practice location:
  • Phone: 701-258-3780
  • Fax: 701-751-1328
Mailing address:
  • Phone: 701-258-3780
  • Fax: 701-751-1328

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLAC-23781
License Number StateAZ
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number1517-12-15-25A
License Number StateND

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: