Provider Demographics
NPI:1851424204
Name:BECK, BRYAN D (MS, LPCC)
Entity Type:Individual
Prefix:
First Name:BRYAN
Middle Name:D
Last Name:BECK
Suffix:
Gender:M
Credentials:MS, LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4473 ALIGAN WAY
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40515-4784
Mailing Address - Country:US
Mailing Address - Phone:859-825-8168
Mailing Address - Fax:
Practice Address - Street 1:68 SUMMERTREE DR
Practice Address - Street 2:
Practice Address - City:NICHOLASVILLE
Practice Address - State:KY
Practice Address - Zip Code:40356-9714
Practice Address - Country:US
Practice Address - Phone:859-825-8168
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-14
Last Update Date:2009-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYKY-0966101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional