Provider Demographics
NPI:1710438973
Name:BECKER, SEAN PHILLIP (LCSW, CCTP)
Entity Type:Individual
Prefix:MR
First Name:SEAN
Middle Name:PHILLIP
Last Name:BECKER
Suffix:
Gender:M
Credentials:LCSW, CCTP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:777 E MILTON ST
Mailing Address - Street 2:
Mailing Address - City:LEBANON
Mailing Address - State:OR
Mailing Address - Zip Code:97355-4079
Mailing Address - Country:US
Mailing Address - Phone:925-451-3309
Mailing Address - Fax:
Practice Address - Street 1:777 E MILTON ST
Practice Address - Street 2:
Practice Address - City:LEBANON
Practice Address - State:OR
Practice Address - Zip Code:97355-4079
Practice Address - Country:US
Practice Address - Phone:925-451-3309
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-10-21
Last Update Date:2024-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORL83711041C0700X
101YM0800X
CA644281041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health