Healthcare Provider Details

I. General information

NPI: 1992012629
Provider Name (Legal Business Name): LYNNE A. BECK P.C.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/01/2010
Last Update Date: 09/01/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

611 BELMONT AVE
YOUNGSTOWN OH
44502-1037
US

IV. Provider business mailing address

611 BELMONT AVE
YOUNGSTOWN OH
44502-1037
US

V. Phone/Fax

Practice location:
  • Phone: 330-744-2991
  • Fax: 330-744-2971
Mailing address:
  • Phone: 330-744-2991
  • Fax: 330-744-2971

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberC0800400
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: