Provider Demographics
NPI:1568069938
Name:BECK, MIMI
Entity Type:Individual
Prefix:
First Name:MIMI
Middle Name:
Last Name:BECK
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 1:2850 THE TERRACES WAY
Mailing Address - Street 2:
Mailing Address - City:DACULA
Mailing Address - State:GA
Mailing Address - Zip Code:30019-3166
Mailing Address - Country:US
Mailing Address - Phone:706-654-7761
Mailing Address - Fax:
Practice Address - Street 1:4080 MCGINNIS FERRY RD STE 301
Practice Address - Street 2:
Practice Address - City:ALPHARETTA
Practice Address - State:GA
Practice Address - Zip Code:30005-1737
Practice Address - Country:US
Practice Address - Phone:706-654-7761
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-07
Last Update Date:2020-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician