Provider Demographics
NPI:1376847483
Name:BECK, SUSAN KREH (LPES, SCHOOLPSYCH II)
Entity Type:Individual
Prefix:MRS
First Name:SUSAN
Middle Name:KREH
Last Name:BECK
Suffix:
Gender:F
Credentials:LPES, SCHOOLPSYCH II
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:304 FIREBRIDGE RD
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29223-5122
Mailing Address - Country:US
Mailing Address - Phone:803-206-5343
Mailing Address - Fax:
Practice Address - Street 1:304 FIREBRIDGE RD
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29223-5122
Practice Address - Country:US
Practice Address - Phone:803-206-5343
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-04
Last Update Date:2011-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC3753103TB0200X, 103TM1800X, 103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool
No103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral
No103TM1800XBehavioral Health & Social Service ProvidersPsychologistIntellectual & Developmental Disabilities