Provider Demographics
NPI:1477093854
Name:EIDE, BECKA RAE (MED, LCPC)
Entity Type:Individual
Prefix:
First Name:BECKA
Middle Name:RAE
Last Name:EIDE
Suffix:
Gender:F
Credentials:MED, LCPC
Other - Prefix:
Other - First Name:BECKA
Other - Middle Name:RAE
Other - Last Name:GLEASON OR SWANKE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1732 S 72ND ST W
Mailing Address - Street 2:
Mailing Address - City:BILLINGS
Mailing Address - State:MT
Mailing Address - Zip Code:59106-3538
Mailing Address - Country:US
Mailing Address - Phone:406-651-2814
Mailing Address - Fax:
Practice Address - Street 1:1732 S 72ND ST W
Practice Address - Street 2:
Practice Address - City:BILLINGS
Practice Address - State:MT
Practice Address - Zip Code:59106-3538
Practice Address - Country:US
Practice Address - Phone:406-651-2814
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-03
Last Update Date:2017-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTBBH-LCPC-LIC-23177101YM0800X
MTSWP-LCPC-LIC-11538251300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No251300000XAgenciesLocal Education Agency (LEA)
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT81-02622019Medicaid