Provider Demographics
NPI:1609106111
Name:BECK, KANANI MAKAYLA LYNN
Entity Type:Individual
Prefix:
First Name:KANANI
Middle Name:MAKAYLA LYNN
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 1:20033 BAGLEY DR N
Mailing Address - Street 2:APT X203
Mailing Address - City:SHORELINE
Mailing Address - State:WA
Mailing Address - Zip Code:98133-2753
Mailing Address - Country:US
Mailing Address - Phone:707-478-3274
Mailing Address - Fax:
Practice Address - Street 1:3320 173RD PL NE
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:WA
Practice Address - Zip Code:98223-8712
Practice Address - Country:US
Practice Address - Phone:707-478-3274
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-01-05
Last Update Date:2010-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health