MEDICARE: MR. TODD CHARLES BECKER LMSW

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	1041C0700X	Clinical Social Worker	6802089782	MI

General Provider Information

NPI Number	:	1568979839
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. TODD CHARLES BECKER LMSW

Provider Business Mailing Address
First Line	:	6639 CENTURION DR STE 130
Second Line	:
City	:	LANSING
State	:	MI
Zip	:	48917-8273
Country	:	US
Telephone Number	:	517-322-3050
Fax Number	:	517-709-7701

Provider Business Practice Location Address
First Line	:	6639 CENTURION DR STE 130
Second Line	:
City	:	LANSING
State	:	MI
Zip	:	48917-8273
Country	:	US
Telephone Number	:	517-322-3050
Fax Number	:	517-709-7701

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

Provider Enumeration Date	:	01/08/2018
Last Update Date	:	09/27/2023

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