Provider Demographics
NPI:1396821856
Name:BECKMAN, GARY LOYAL (CCP, LCP)
Entity Type:Individual
Prefix:MR
First Name:GARY
Middle Name:LOYAL
Last Name:BECKMAN
Suffix:
Gender:M
Credentials:CCP, LCP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4803 NEW AIRLINE RD
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TN
Mailing Address - Zip Code:38002-9586
Mailing Address - Country:US
Mailing Address - Phone:901-867-4867
Mailing Address - Fax:901-867-0569
Practice Address - Street 1:4803 NEW AIRLINE RD
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:TN
Practice Address - Zip Code:38002-9586
Practice Address - Country:US
Practice Address - Phone:901-867-2815
Practice Address - Fax:901-867-0569
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
TN00001174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist