Provider Demographics
NPI:1497221766
Name:BECKMAN, MICAH JEAN
Entity Type:Individual
Prefix:
First Name:MICAH
Middle Name:JEAN
Last Name:BECKMAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:MICAH
Other - Middle Name:
Other - Last Name:BECKMAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LMSW
Mailing Address - Street 1:6180 W SANBORN RD
Mailing Address - Street 2:
Mailing Address - City:LAKE CITY
Mailing Address - State:MI
Mailing Address - Zip Code:49651-8848
Mailing Address - Country:US
Mailing Address - Phone:231-236-7597
Mailing Address - Fax:
Practice Address - Street 1:6180 W SANBORN RD
Practice Address - Street 2:
Practice Address - City:LAKE CITY
Practice Address - State:MI
Practice Address - Zip Code:49651-8848
Practice Address - Country:US
Practice Address - Phone:231-236-7597
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-15
Last Update Date:2019-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
104100000X
MI68011058451041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker