Healthcare Provider Details

I. General information

NPI: 1578703807
Provider Name (Legal Business Name): HARRY JACOB BECK MT-BC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/26/2009
Last Update Date: 11/06/2023
Certification Date: 11/06/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2948 SE 3RD AVE
CAMAS WA
98607-2321
US

IV. Provider business mailing address

2948 SE 3RD AVE
CAMAS WA
98607-2321
US

V. Phone/Fax

Practice location:
  • Phone: 360-525-3360
  • Fax:
Mailing address:
  • Phone: 715-294-3828
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225A00000X
TaxonomyMusic Therapist
License Number89061
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: