Provider Demographics
NPI:1679635411
Name:BECKER, GARY (LCSW, PHD)
Entity Type:Individual
Prefix:
First Name:GARY
Middle Name:
Last Name:BECKER
Suffix:
Gender:M
Credentials:LCSW, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8711 WATSON RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63119-5100
Mailing Address - Country:US
Mailing Address - Phone:314-961-9871
Mailing Address - Fax:314-961-9877
Practice Address - Street 1:10199 WOODFIELD LN
Practice Address - Street 2:
Practice Address - City:OLIVETTE
Practice Address - State:MO
Practice Address - Zip Code:63132-2922
Practice Address - Country:US
Practice Address - Phone:314-298-0023
Practice Address - Fax:314-997-1111
Is Sole Proprietor?:No
Enumeration Date:2006-12-15
Last Update Date:2016-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO001193101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health