Provider Demographics
NPI:1538666920
Name:EEDS, BECKY LAVERNE
Entity Type:Individual
Prefix:
First Name:BECKY
Middle Name:LAVERNE
Last Name:EEDS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1527
Mailing Address - Street 2:
Mailing Address - City:IDABEL
Mailing Address - State:OK
Mailing Address - Zip Code:74745-1527
Mailing Address - Country:US
Mailing Address - Phone:580-286-6639
Mailing Address - Fax:580-286-5206
Practice Address - Street 1:2000 E LINCOLN RD
Practice Address - Street 2:
Practice Address - City:IDABEL
Practice Address - State:OK
Practice Address - Zip Code:74745-7353
Practice Address - Country:US
Practice Address - Phone:580-286-6639
Practice Address - Fax:580-286-5206
Is Sole Proprietor?:No
Enumeration Date:2018-04-11
Last Update Date:2018-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No175T00000XOther Service ProvidersPeer Specialist