Provider Demographics
NPI:1790283919
Name:BECKWITH, JULIE LYNN (PSYD)
Entity Type:Individual
Prefix:
First Name:JULIE
Middle Name:LYNN
Last Name:BECKWITH
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:JULIE
Other - Middle Name:
Other - Last Name:BUCZYNSKI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2201 COUSTEAU DR
Mailing Address - Street 2:
Mailing Address - City:WEST LAFAYETTE
Mailing Address - State:IN
Mailing Address - Zip Code:47906-5196
Mailing Address - Country:US
Mailing Address - Phone:574-220-8704
Mailing Address - Fax:
Practice Address - Street 1:703 3RD ST
Practice Address - Street 2:
Practice Address - City:WEST LAFAYETTE
Practice Address - State:IN
Practice Address - Zip Code:47907-2081
Practice Address - Country:US
Practice Address - Phone:765-494-6995
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-01-23
Last Update Date:2018-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN20042933A103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical