Provider Demographics
NPI:1407360928
Name:PAMELA BECKER, MA, LMFT LLC
Entity Type:Organization
Organization Name:PAMELA BECKER, MA, LMFT LLC
Other - Org Name:NORHTWEST COUNSELING
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PROVIDER/THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:PAMELA
Authorized Official - Middle Name:
Authorized Official - Last Name:BECKER
Authorized Official - Suffix:
Authorized Official - Credentials:MA, LMFT
Authorized Official - Phone:320-282-7445
Mailing Address - Street 1:811 1ST AVE N
Mailing Address - Street 2:
Mailing Address - City:SARTELL
Mailing Address - State:MN
Mailing Address - Zip Code:56377-1437
Mailing Address - Country:US
Mailing Address - Phone:320-282-7445
Mailing Address - Fax:
Practice Address - Street 1:2351 CONNECTICUT AVE S STE 105
Practice Address - Street 2:
Practice Address - City:SARTELL
Practice Address - State:MN
Practice Address - Zip Code:56377-2479
Practice Address - Country:US
Practice Address - Phone:320-316-0288
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-11-20
Last Update Date:2017-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1963106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN1073761631Medicaid