Healthcare Provider Details

I. General information

NPI: 1497921332
Provider Name (Legal Business Name): MILTON E. BECKNELL, PH.D., LLC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/30/2008
Last Update Date: 02/24/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7244 FAR HILLS AVE
CENTERVILLE OH
45459-4207
US

IV. Provider business mailing address

7244 FAR HILLS AVE
CENTERVILLE OH
45459-4207
US

V. Phone/Fax

Practice location:
  • Phone: 937-684-2035
  • Fax: 937-395-1311
Mailing address:
  • Phone: 937-684-2035
  • Fax: 937-395-1311

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number5682
License Number StateOH

VIII. Authorized Official

Name: DR. MILTON EDWARD BECKNELL
Title or Position: CLINICAL PSYCHOLOGIST
Credential: PH.D.
Phone: 937-684-2035