Provider Demographics
NPI:1942603782
Name:BECK, CORAL (LCSW)
Entity Type:Individual
Prefix:
First Name:CORAL
Middle Name:
Last Name:BECK
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 363
Mailing Address - Street 2:
Mailing Address - City:LOLO
Mailing Address - State:MT
Mailing Address - Zip Code:59847-0363
Mailing Address - Country:US
Mailing Address - Phone:406-240-1809
Mailing Address - Fax:
Practice Address - Street 1:700 SOUTH AVE W
Practice Address - Street 2:SUITE F
Practice Address - City:MISSOULA
Practice Address - State:MT
Practice Address - Zip Code:59801-8000
Practice Address - Country:US
Practice Address - Phone:406-240-1809
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-08
Last Update Date:2014-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTSWP-LCSW-LIC-85881041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical