Provider Demographics
NPI:1275619025
Name:BECKER, PAULA MOTT (MA LP)
Entity Type:Individual
Prefix:MRS
First Name:PAULA
Middle Name:MOTT
Last Name:BECKER
Suffix:
Gender:F
Credentials:MA LP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17305 CEDAR AVE SOUTH
Mailing Address - Street 2:SUITE 230
Mailing Address - City:LAKEVILLE
Mailing Address - State:MN
Mailing Address - Zip Code:55044
Mailing Address - Country:US
Mailing Address - Phone:952-435-4144
Mailing Address - Fax:952-435-4149
Practice Address - Street 1:17305 CEDAR AVE SOUTH
Practice Address - Street 2:SUITE 230
Practice Address - City:LAKEVILLE
Practice Address - State:MN
Practice Address - Zip Code:55044
Practice Address - Country:US
Practice Address - Phone:952-435-4144
Practice Address - Fax:952-435-4149
Is Sole Proprietor?:No
Enumeration Date:2006-10-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNLP2617101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN01026803OtherPREFERRED ONE
MN6273355OtherMEDICA
MN35Q96BEOtherBLUE CROSS