Healthcare Provider Details

I. General information

NPI: 1386116176
Provider Name (Legal Business Name): JENNIFER BECK LMFT, LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/18/2018
Last Update Date: 12/04/2020
Certification Date: 12/04/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 E 2ND AVE STE 104E
EUGENE OR
97401-2452
US

IV. Provider business mailing address

400 E 2ND AVE STE 104E
EUGENE OR
97401-2452
US

V. Phone/Fax

Practice location:
  • Phone: 541-224-7712
  • Fax:
Mailing address:
  • Phone: 541-224-7712
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberC5111
License Number StateOR
# 2
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberT1692
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: