Healthcare Provider Details

I. General information

NPI: 1669788105
Provider Name (Legal Business Name): RICKY LEE BECKER LMSW, CSWA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/22/2010
Last Update Date: 05/10/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

160 SW SCALE HSE LOOP SUITE 160
BEND OR
97702-1284
US

IV. Provider business mailing address

474 NE EMERSON AVE
BEND OR
97701-4939
US

V. Phone/Fax

Practice location:
  • Phone: 541-312-4316
  • Fax:
Mailing address:
  • Phone: 262-389-6778
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberM6052
License Number StateOR
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberA6052
License Number StateOR

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: