=====================================================
General NPI Number Information
=====================================================
NPI Number | 1295837771
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MILTON EDWARD BECKNELL PH.D.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/03/2006
-----------------------------------------------------
Last Update Date | 03/30/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 7244 FAR HILLS AVE
-----------------------------------------------------
City | CENTERVILLE
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 45459-4207
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 937-684-2035
-----------------------------------------------------
Fax | 937-395-1311
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 7244 FAR HILLS AVE
-----------------------------------------------------
City | CENTERVILLE
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 45459-4207
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 937-684-2035
-----------------------------------------------------
Fax | 937-395-1311
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 103TH0100X
-----------------------------------------------------
Taxonomy Name | Health Service Psychologist
-----------------------------------------------------
License Number | 5682
-----------------------------------------------------
License Number State | OH
-----------------------------------------------------