Healthcare Provider Details

I. General information

NPI: 1700299187
Provider Name (Legal Business Name): KATHERINE VICTORIA BECK LPCC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/03/2014
Last Update Date: 06/26/2026
Certification Date: 06/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

45 KIVA RD
MIMBRES NM
88049-8026
US

IV. Provider business mailing address

45 KIVA RD
MIMBRES NM
88049-8026
US

V. Phone/Fax

Practice location:
  • Phone: 575-740-1562
  • Fax:
Mailing address:
  • Phone: 575-740-1562
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberCCMH0185771
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: