MEDICARE: THOMAS EDWARD BECK PHD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TC1900X	Counseling Psychologist	LH00003843	WA

General Provider Information

NPI Number	:	1124180484
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	THOMAS EDWARD BECK PHD

Provider Business Mailing Address
First Line	:	4649 SUNNYSIDE AVE N
Second Line	:	STE 341
City	:	SEATTLE
State	:	WA
Zip	:	98103-6955
Country	:	US
Telephone Number	:	206-329-9235
Fax Number	:

Provider Business Practice Location Address
First Line	:	4649 SUNNYSIDE AVE N
Second Line	:	STE 341
City	:	SEATTLE
State	:	WA
Zip	:	98103-6955
Country	:	US
Telephone Number	:	206-329-9235
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/14/2006
Last Update Date	:	07/08/2007

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