Provider Demographics
NPI:1679342604
Name:BECK, MARANDA LEIGH
Entity Type:Individual
Prefix:
First Name:MARANDA
Middle Name:LEIGH
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 1:19136 LONAGER LN
Mailing Address - Street 2:
Mailing Address - City:WAYNESVILLE
Mailing Address - State:MO
Mailing Address - Zip Code:65583-7810
Mailing Address - Country:US
Mailing Address - Phone:573-528-5967
Mailing Address - Fax:
Practice Address - Street 1:704 HISTORIC 66 W STE 101
Practice Address - Street 2:
Practice Address - City:WAYNESVILLE
Practice Address - State:MO
Practice Address - Zip Code:65583-8322
Practice Address - Country:US
Practice Address - Phone:573-433-4846
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-02
Last Update Date:2024-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2023038167101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional