Provider Demographics
NPI:1689119687
Name:BECKER, CAROLYN (LPC CANDIDATE)
Entity Type:Individual
Prefix:
First Name:CAROLYN
Middle Name:
Last Name:BECKER
Suffix:
Gender:F
Credentials:LPC CANDIDATE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9038 E 94TH ST
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74133-5659
Mailing Address - Country:US
Mailing Address - Phone:918-630-1509
Mailing Address - Fax:
Practice Address - Street 1:6262 S SHERIDAN RD
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74133-4055
Practice Address - Country:US
Practice Address - Phone:918-493-3201
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-12-29
Last Update Date:2016-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health