Provider Demographics
NPI:1194026443
Name:BECKLEY, CLARK Q (LCSW)
Entity Type:Individual
Prefix:MR
First Name:CLARK
Middle Name:Q
Last Name:BECKLEY
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4745 MAIN ST
Mailing Address - Street 2:SUITE 207
Mailing Address - City:LISLE
Mailing Address - State:IL
Mailing Address - Zip Code:60532-1754
Mailing Address - Country:US
Mailing Address - Phone:630-442-1895
Mailing Address - Fax:630-442-1895
Practice Address - Street 1:4745 MAIN ST
Practice Address - Street 2:SUITE 207
Practice Address - City:LISLE
Practice Address - State:IL
Practice Address - Zip Code:60532-1754
Practice Address - Country:US
Practice Address - Phone:630-442-1895
Practice Address - Fax:630-442-1895
Is Sole Proprietor?:No
Enumeration Date:2010-11-03
Last Update Date:2016-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL149.0169451041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical