1154612216 NPI number — GINA M. BECK L.C.S.W.

NPI Number: 1154612216
Health Care Provider/Practitioner: GINA M. BECK L.C.S.W.

NPI Number : 1154612216 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1154612216",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "Y",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "BECK",
    "FirstName": "GINA",
    "MiddleName": "M.",
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": "L.C.S.W.",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "6451 MCCALL ST STE D",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "BONNERS FERRY",
    "MailingAddressStateName": "ID",
    "MailingAddressPostalCode": "83805-8525",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "208-304-2657",
    "MailingAddressFaxNumber": "208-215-2473",
    "FirstLinePracticeLocationAddress": "6451 MCCALL ST STE D",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "BONNERS FERRY",
    "PracticeLocationAddressStateName": "ID",
    "PracticeLocationAddressPostalCode": "83805-8525",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "208-304-2657",
    "PracticeLocationAddressFaxNumber": "208-215-2473",
    "EnumerationDate": "04/25/2011",
    "LastUpdateDate": "10/31/2022",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": "F",
    "Gender": "Female",
    "AuthorizedOfficialLastName": null,
    "AuthorizedOfficialFirstName": null,
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": null,
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": null,
    "Taxonomies": {
      "Taxonomy": [
        {
          "TaxonomyCode": "1041C0700X",
          "TaxonomyName": "Clinical Social Worker",
          "LicenseNumber": "LCS 18467",
          "LicenseNumberStateCode": "CA",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "1041C0700X",
          "TaxonomyName": "Clinical Social Worker",
          "LicenseNumber": "LCSW 30443",
          "LicenseNumberStateCode": "ID",
          "PrimaryTaxonomySwitch": "Y"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}