Provider Demographics
NPI:1225391055
Name:NAGY, BECKY (PSYD)
Entity Type:Individual
Prefix:DR
First Name:BECKY
Middle Name:
Last Name:NAGY
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:57239 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:THREE RIVERS
Mailing Address - State:MI
Mailing Address - Zip Code:49093-9419
Mailing Address - Country:US
Mailing Address - Phone:616-235-4800
Mailing Address - Fax:
Practice Address - Street 1:57239 N MAIN ST
Practice Address - Street 2:
Practice Address - City:THREE RIVERS
Practice Address - State:MI
Practice Address - Zip Code:49093-9419
Practice Address - Country:US
Practice Address - Phone:269-273-0030
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-18
Last Update Date:2016-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN20042382A103TC0700X
MI6301014295103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIM54203001OtherMEDICARE