Healthcare Provider Details

I. General information

NPI: 1093902017
Provider Name (Legal Business Name): SUE BECKLEY, LMFT, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/03/2007
Last Update Date: 10/03/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2722 COLBY AVE SUITE 706
EVERETT WA
98201-3557
US

IV. Provider business mailing address

2722 COLBY AVE SUITE 706
EVERETT WA
98201-3557
US

V. Phone/Fax

Practice location:
  • Phone: 425-252-1049
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License NumberLF00001374
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License NumberLF00001374
License Number StateWA

VIII. Authorized Official

Name: SUE BECKLEY
Title or Position: PRESIDENT
Credential: M.ED.
Phone: 425-252-1049