Provider Demographics
NPI:1275269045
Name:BECKWITH, MALLORY (LPC-ASSOCIATE)
Entity Type:Individual
Prefix:
First Name:MALLORY
Middle Name:
Last Name:BECKWITH
Suffix:
Gender:F
Credentials:LPC-ASSOCIATE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5106 EILERS AVE # 2
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78751-2113
Mailing Address - Country:US
Mailing Address - Phone:702-742-4989
Mailing Address - Fax:
Practice Address - Street 1:5106 EILERS AVE # 2
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78751-2113
Practice Address - Country:US
Practice Address - Phone:702-742-4989
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-25
Last Update Date:2022-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX87801101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health