Provider Demographics
NPI:1659644755
Name:BECKETT-AVERY, LAURA ANN (LISW-S)
Entity Type:Individual
Prefix:MRS
First Name:LAURA
Middle Name:ANN
Last Name:BECKETT-AVERY
Suffix:
Gender:F
Credentials:LISW-S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:582 N CABLE RD
Mailing Address - Street 2:
Mailing Address - City:LIMA
Mailing Address - State:OH
Mailing Address - Zip Code:45805-2133
Mailing Address - Country:US
Mailing Address - Phone:419-996-2500
Mailing Address - Fax:419-996-2509
Practice Address - Street 1:582 N CABLE RD
Practice Address - Street 2:
Practice Address - City:LIMA
Practice Address - State:OH
Practice Address - Zip Code:45805-2133
Practice Address - Country:US
Practice Address - Phone:419-996-2500
Practice Address - Fax:419-996-2509
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-21
Last Update Date:2019-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHS11003201041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical