Provider Demographics
NPI:1093487506
Name:BECKER, RICHARD MICHAEL
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:MICHAEL
Last Name:BECKER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2013 EASTCASTLE DR SE STE B
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49508-8873
Mailing Address - Country:US
Mailing Address - Phone:616-204-0308
Mailing Address - Fax:616-469-1113
Practice Address - Street 1:2013 EASTCASTLE DR SE STE B
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49508-8873
Practice Address - Country:US
Practice Address - Phone:616-204-0308
Practice Address - Fax:616-469-1113
Is Sole Proprietor?:No
Enumeration Date:2021-10-03
Last Update Date:2021-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6362009275103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist