Provider Demographics
NPI:1972049815
Name:BECKMAN, KAYLA (MA LPC INTERN)
Entity Type:Individual
Prefix:
First Name:KAYLA
Middle Name:
Last Name:BECKMAN
Suffix:
Gender:F
Credentials:MA LPC INTERN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:637 NE 188TH AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97230-7111
Mailing Address - Country:US
Mailing Address - Phone:503-347-6744
Mailing Address - Fax:
Practice Address - Street 1:637 NE 188TH AVE
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97230-7111
Practice Address - Country:US
Practice Address - Phone:503-347-6744
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-17
Last Update Date:2017-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORR4388101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health