Healthcare Provider Details

I. General information

NPI: 1215275136
Provider Name (Legal Business Name): STEPHEN BECK
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/28/2013
Last Update Date: 12/16/2022
Certification Date: 12/16/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

433 S DIAMOND RANCH PKWY W
HURRICANE UT
84737-3020
US

IV. Provider business mailing address

937 S PEACHTREE DR
TOQUERVILLE UT
84774-5019
US

V. Phone/Fax

Practice location:
  • Phone: 435-632-2647
  • Fax:
Mailing address:
  • Phone: 435-632-2647
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number9543907-3501
License Number StateUT
# 2
Primary TaxonomyN
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: