Provider Demographics
NPI:1497921332
Name:MILTON E. BECKNELL, PH.D., LLC.
Entity Type:Organization
Organization Name:MILTON E. BECKNELL, PH.D., LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:MILTON
Authorized Official - Middle Name:EDWARD
Authorized Official - Last Name:BECKNELL
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:937-684-2035
Mailing Address - Street 1:7244 FAR HILLS AVE
Mailing Address - Street 2:
Mailing Address - City:CENTERVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:45459-4207
Mailing Address - Country:US
Mailing Address - Phone:937-684-2035
Mailing Address - Fax:937-395-1311
Practice Address - Street 1:7244 FAR HILLS AVE
Practice Address - Street 2:
Practice Address - City:CENTERVILLE
Practice Address - State:OH
Practice Address - Zip Code:45459-4207
Practice Address - Country:US
Practice Address - Phone:937-684-2035
Practice Address - Fax:937-395-1311
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-30
Last Update Date:2014-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH5682103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH7155596OtherAETNA
OH500973319OtherUNITED BEHAVIORAL HEALTH
OH000000351504OtherANTHEM BLUE CROSS BLUE SHIELD; BLUE CROSS BLUE SHIELD FEDERAL
OH7155596OtherAETNA
CP30281Medicare UPIN
OH500973319OtherUNITED BEHAVIORAL HEALTH