Provider Demographics
NPI:1952654584
Name:BECKETT, TARA C (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:TARA
Middle Name:C
Last Name:BECKETT
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 1:2301 S STONE CREEK BLVD
Mailing Address - Street 2:
Mailing Address - City:URBANA
Mailing Address - State:IL
Mailing Address - Zip Code:61802-9410
Mailing Address - Country:US
Mailing Address - Phone:217-898-5632
Mailing Address - Fax:
Practice Address - Street 1:1921 N MARKET ST
Practice Address - Street 2:
Practice Address - City:MONTICELLO
Practice Address - State:IL
Practice Address - Zip Code:61856-8144
Practice Address - Country:US
Practice Address - Phone:217-762-5371
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-10-19
Last Update Date:2012-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1490096191041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical