Provider Demographics
NPI:1225657943
Name:BECK, TEESHA
Entity Type:Individual
Prefix:MRS
First Name:TEESHA
Middle Name:
Last Name:BECK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3851 W COBBLE RIDGE DR APT 1304
Mailing Address - Street 2:
Mailing Address - City:WEST JORDAN
Mailing Address - State:UT
Mailing Address - Zip Code:84084-4904
Mailing Address - Country:US
Mailing Address - Phone:208-360-8366
Mailing Address - Fax:
Practice Address - Street 1:3851 W COBBLE RIDGE DR APT 1304
Practice Address - Street 2:
Practice Address - City:WEST JORDAN
Practice Address - State:UT
Practice Address - Zip Code:84084-4904
Practice Address - Country:US
Practice Address - Phone:208-360-8366
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-04-13
Last Update Date:2020-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician