Provider Demographics
NPI:1699369686
Name:BECK, BYLLIE JEAN GWYN (LICSW)
Entity Type:Individual
Prefix:
First Name:BYLLIE JEAN
Middle Name:GWYN
Last Name:BECK
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3205 COUNTY ROAD 144
Mailing Address - Street 2:
Mailing Address - City:WAUBUN
Mailing Address - State:MN
Mailing Address - Zip Code:56589-9008
Mailing Address - Country:US
Mailing Address - Phone:218-556-6919
Mailing Address - Fax:
Practice Address - Street 1:24246 CRANE ROAD
Practice Address - Street 2:
Practice Address - City:WHITE EARTH
Practice Address - State:MN
Practice Address - Zip Code:56591
Practice Address - Country:US
Practice Address - Phone:218-983-4703
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-02-22
Last Update Date:2021-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN206311041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical