Provider Demographics
NPI:1922271212
Name:BECK, KERRY J (LISW)
Entity Type:Individual
Prefix:MR
First Name:KERRY
Middle Name:J
Last Name:BECK
Suffix:
Gender:M
Credentials:LISW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:207 VINE STREET
Mailing Address - Street 2:
Mailing Address - City:ARCHBOLD
Mailing Address - State:OH
Mailing Address - Zip Code:43502
Mailing Address - Country:US
Mailing Address - Phone:419-445-1552
Mailing Address - Fax:419-445-1401
Practice Address - Street 1:207 VINE ST
Practice Address - Street 2:
Practice Address - City:ARCHBOLD
Practice Address - State:OH
Practice Address - Zip Code:43502-1224
Practice Address - Country:US
Practice Address - Phone:419-445-1552
Practice Address - Fax:419-455-1401
Is Sole Proprietor?:No
Enumeration Date:2008-04-08
Last Update Date:2008-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI.0700134101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health