Provider Demographics
NPI:1093336653
Name:BECK, PATRICK SHANE (LPC)
Entity Type:Individual
Prefix:
First Name:PATRICK
Middle Name:SHANE
Last Name:BECK
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13235 COUNTY ROAD 2925
Mailing Address - Street 2:
Mailing Address - City:MABANK
Mailing Address - State:TX
Mailing Address - Zip Code:75156-7817
Mailing Address - Country:US
Mailing Address - Phone:903-880-3183
Mailing Address - Fax:
Practice Address - Street 1:13235 COUNTY ROAD 2925
Practice Address - Street 2:
Practice Address - City:MABANK
Practice Address - State:TX
Practice Address - Zip Code:75156-7817
Practice Address - Country:US
Practice Address - Phone:903-880-3183
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-05-05
Last Update Date:2020-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX79454101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional