Provider Demographics
NPI:1700857364
Name:BECKER-WITT, MARY K (LMSW)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:K
Last Name:BECKER-WITT
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1620 SPRUCE ST
Mailing Address - Street 2:
Mailing Address - City:WELLSTON
Mailing Address - State:MI
Mailing Address - Zip Code:49689-9597
Mailing Address - Country:US
Mailing Address - Phone:231-848-4528
Mailing Address - Fax:
Practice Address - Street 1:395 3RD ST
Practice Address - Street 2:
Practice Address - City:MANISTEE
Practice Address - State:MI
Practice Address - Zip Code:49660-1718
Practice Address - Country:US
Practice Address - Phone:231-309-1813
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6801015556101YM0800X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Not Answered1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI6801015556OtherSTATE LICENSE NUMBER
MIMW015556Other3RD PARTY IDENTIFIER
MIE16035018Medicare ID - Type UnspecifiedLMSW