=====================================================
General NPI Number Information
=====================================================
NPI Number | 1205958907
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | BECKY A. SPRINGSTON LCSW
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/04/2007
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1505 N MARKET ST STE 6A
-----------------------------------------------------
City | SPARTA
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 62286-1077
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 618-443-2228
-----------------------------------------------------
Fax | 618-443-6704
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 439 1505 N. MARKET, SUITE 6A
-----------------------------------------------------
City | SPARTA
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 62286-0439
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 618-443-2228
-----------------------------------------------------
Fax | 618-443-6704
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number | 1491005691
-----------------------------------------------------
License Number State | IL
-----------------------------------------------------