MEDICARE: JOSHUA BECKHAM

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	106S00000X	Behavior Technician

General Provider Information

NPI Number	:	1396381323
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOSHUA BECKHAM

Provider Business Mailing Address
First Line	:	4985 NW 41ST LN
Second Line	:
City	:	GAINESVILLE
State	:	FL
Zip	:	32606-4602
Country	:	US
Telephone Number	:	352-304-4964
Fax Number	:

Provider Business Practice Location Address
First Line	:	1000 NE 16TH AVE BLDG D
Second Line	:
City	:	GAINESVILLE
State	:	FL
Zip	:	32601-4541
Country	:	US
Telephone Number	:	352-332-8588
Fax Number	:

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

Provider Enumeration Date	:	11/25/2019
Last Update Date	:	11/25/2019

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Directions to “ JOSHUA BECKHAM ” Practice Location

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