MEDICARE: SHANNON BECKER

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	101YM0800X	Mental Health Counselor
2	106H00000X	Marriage & Family Therapist	MI0734	NV
3	390200000X	Student in an Organized Health Care Education/Training Program
4	101YM0800X	Mental Health Counselor	CI0187	NV

General Provider Information

NPI Number	:	1871937581
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHANNON BECKER

Provider Business Mailing Address
First Line	:	8430 W LAKE MEAD BLVD
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89128-7672
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	8430 W LAKE MEAD BLVD
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89128-7672
Country	:	US
Telephone Number	:	702-497-0080
Fax Number	:

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

Provider Enumeration Date	:	04/24/2013
Last Update Date	:	12/11/2023

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Directions to “ SHANNON BECKER ” Practice Location

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