Provider Demographics
NPI:1750665022
Name:CARY FAMILY THERAPY, PLLC
Entity Type:Organization
Organization Name:CARY FAMILY THERAPY, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:RENEE
Authorized Official - Last Name:BECKMANN
Authorized Official - Suffix:
Authorized Official - Credentials:MA, LMFT
Authorized Official - Phone:919-740-2444
Mailing Address - Street 1:1143 EXECUTIVE CIR STE B
Mailing Address - Street 2:SUITE 201
Mailing Address - City:CARY
Mailing Address - State:NC
Mailing Address - Zip Code:27511-4571
Mailing Address - Country:US
Mailing Address - Phone:919-740-2444
Mailing Address - Fax:919-724-4104
Practice Address - Street 1:1143 EXECUTIVE CIR STE B
Practice Address - Street 2:SUITE 201
Practice Address - City:CARY
Practice Address - State:NC
Practice Address - Zip Code:27511-4571
Practice Address - Country:US
Practice Address - Phone:919-740-2444
Practice Address - Fax:919-724-4104
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-10-05
Last Update Date:2012-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1341106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6105286Medicaid