Provider Demographics
NPI:1275779621
Name:ROSS M AND FRANCES E.BECKER A PROFESSIONAL CORPORATION
Entity Type:Organization
Organization Name:ROSS M AND FRANCES E.BECKER A PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ROSS
Authorized Official - Middle Name:M
Authorized Official - Last Name:BECKER
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:559-636-1885
Mailing Address - Street 1:PO BOX 8078
Mailing Address - Street 2:SUITE A
Mailing Address - City:VISALIA
Mailing Address - State:CA
Mailing Address - Zip Code:93290-8078
Mailing Address - Country:US
Mailing Address - Phone:559-636-1885
Mailing Address - Fax:
Practice Address - Street 1:401 N CHURCH ST
Practice Address - Street 2:
Practice Address - City:VISALIA
Practice Address - State:CA
Practice Address - Zip Code:93291-5006
Practice Address - Country:US
Practice Address - Phone:559-636-1885
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-06
Last Update Date:2012-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS33871041C0700X
CALCS40681041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ55165YOtherBLUE SHIELD OF CALIFORNIA