Healthcare Provider Details

I. General information

NPI: 1245177948
Provider Name (Legal Business Name): KRISTINE BECKETT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/30/2026
Last Update Date: 04/30/2026
Certification Date: 04/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4234 PARKCLIFF LN
TOLEDO OH
43615-7113
US

IV. Provider business mailing address

4234 PARKCLIFF LN
TOLEDO OH
43615-7113
US

V. Phone/Fax

Practice location:
  • Phone: 567-277-0146
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number195631
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: