Provider Demographics
NPI:1194864140
Name:BECKER, STEPHEN WESLEY (PSY D)
Entity Type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:WESLEY
Last Name:BECKER
Suffix:
Gender:M
Credentials:PSY D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 WOODCHASE DR
Mailing Address - Street 2:APT 24
Mailing Address - City:FARMINGTON
Mailing Address - State:MO
Mailing Address - Zip Code:63640-1428
Mailing Address - Country:US
Mailing Address - Phone:636-789-3494
Mailing Address - Fax:636-789-3824
Practice Address - Street 1:424 MAIN ST
Practice Address - Street 2:
Practice Address - City:HILLSBORO
Practice Address - State:MO
Practice Address - Zip Code:63050
Practice Address - Country:US
Practice Address - Phone:636-789-3494
Practice Address - Fax:636-789-3824
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOLC0741199103TF0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TF0200XBehavioral Health & Social Service ProvidersPsychologistForensic
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO2000159802OtherMO LIC PSYCHOLOGIST
MO0007132Medicare ID - Type Unspecified