Healthcare Provider Details

I. General information

NPI: 1851948632
Provider Name (Legal Business Name): JONATHAN P BECKHAM
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/26/2019
Last Update Date: 04/07/2026
Certification Date: 04/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2102 CROMLEY CIR
MYRTLE BEACH SC
29577-3187
US

IV. Provider business mailing address

2102 CROMLEY CIR
MYRTLE BEACH SC
29577-3187
US

V. Phone/Fax

Practice location:
  • Phone: 843-793-2104
  • Fax:
Mailing address:
  • Phone: 843-793-2104
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: