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General NPI Number Information
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NPI Number | 1780341016
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Entity Type | Individual
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Provider Name | AMI BROOKE BECKMAN TCADC, MSW
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Gender | Female
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Dates
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Enumeration Date | 11/22/2021
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Last Update Date | 11/22/2021
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Provider Practice Location Address
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Address Line | 9245 W HIGHWAY 80
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City | NANCY
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State | KY
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Zip | 42544-8767
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Country | US
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Telephone | 606-288-0013
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Fax | 606-288-0013
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Provider Business Mailing Address
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Address Line | 229 CLOVER POINTE DR
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City | SOMERSET
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State | KY
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Zip | 42503-5802
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Country | US
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Telephone | 606-802-1083
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Fax |
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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 | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 260519
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License Number State | KY
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