Provider Demographics
NPI:1750027058
Name:BECKER, TANYA KAY (LMSW)
Entity Type:Individual
Prefix:
First Name:TANYA
Middle Name:KAY
Last Name:BECKER
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 1:207 N KANSAS ST
Mailing Address - Street 2:
Mailing Address - City:RUSSELL
Mailing Address - State:KS
Mailing Address - Zip Code:67665-2035
Mailing Address - Country:US
Mailing Address - Phone:913-982-7731
Mailing Address - Fax:
Practice Address - Street 1:208 E 8TH ST STE D
Practice Address - Street 2:
Practice Address - City:HAYS
Practice Address - State:KS
Practice Address - Zip Code:67601-4748
Practice Address - Country:US
Practice Address - Phone:207-776-5445
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-09
Last Update Date:2022-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS11704104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker