Provider Demographics
NPI:1790923928
Name:WILBURN-BECKHOM, KATRINA MICHELLE (MS)
Entity Type:Individual
Prefix:MRS
First Name:KATRINA
Middle Name:MICHELLE
Last Name:WILBURN-BECKHOM
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3023 E PARK CT
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:GA
Mailing Address - Zip Code:31705-2542
Mailing Address - Country:US
Mailing Address - Phone:229-436-6909
Mailing Address - Fax:229-436-6903
Practice Address - Street 1:230 S JACKSON ST
Practice Address - Street 2:SUITE 228
Practice Address - City:ALBANY
Practice Address - State:GA
Practice Address - Zip Code:31701-2885
Practice Address - Country:US
Practice Address - Phone:229-317-4728
Practice Address - Fax:229-436-6903
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-26
Last Update Date:2009-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1-03-1465103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst