Provider Demographics
NPI:1922584879
Name:CARLYN BECKER THERAPY SERVICES
Entity Type:Organization
Organization Name:CARLYN BECKER THERAPY SERVICES
Other - Org Name:CARLYN BECKER THERAPY SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:CARLYN
Authorized Official - Middle Name:
Authorized Official - Last Name:BECKER
Authorized Official - Suffix:
Authorized Official - Credentials:MPS, LADC, LPCC
Authorized Official - Phone:763-438-4619
Mailing Address - Street 1:25210 HAZELWOOD DR
Mailing Address - Street 2:
Mailing Address - City:NISSWA
Mailing Address - State:MN
Mailing Address - Zip Code:56468-2797
Mailing Address - Country:US
Mailing Address - Phone:763-438-4619
Mailing Address - Fax:
Practice Address - Street 1:25210 HAZELWOOD DR
Practice Address - Street 2:
Practice Address - City:NISSWA
Practice Address - State:MN
Practice Address - Zip Code:56468-2797
Practice Address - Country:US
Practice Address - Phone:218-821-1208
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CARLYN BECKER THERAPY SERVICES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-07-13
Last Update Date:2023-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN303742251S00000X
MNCC01826251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health