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General NPI Number Information
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NPI Number | 1154612216
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Entity Type | Individual
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Provider Name | GINA M. BECK L.C.S.W.
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Gender | Female
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Dates
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Enumeration Date | 04/25/2011
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Last Update Date | 10/31/2022
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Provider Practice Location Address
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Address Line | 6451 MCCALL ST STE D
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City | BONNERS FERRY
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State | ID
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Zip | 83805-8525
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Country | US
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Telephone | 208-304-2657
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Fax | 208-215-2473
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Provider Business Mailing Address
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Address Line | 6451 MCCALL ST STE D
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City | BONNERS FERRY
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State | ID
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Zip | 83805-8525
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Country | US
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Telephone | 208-304-2657
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Fax | 208-215-2473
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | LCS 18467
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | LCSW 30443
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License Number State | ID
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