Provider Demographics
NPI:1134584501
Name:BECKER, CAROLYN V (MS, LMFT)
Entity type:Individual
Prefix:
First Name:CAROLYN
Middle Name:V
Last Name:BECKER
Suffix:
Gender:F
Credentials:MS, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1540 KELLER PKWY
Mailing Address - Street 2:SUITE 108, UNIT 222
Mailing Address - City:KELLER
Mailing Address - State:TX
Mailing Address - Zip Code:76248-3686
Mailing Address - Country:US
Mailing Address - Phone:817-349-3898
Mailing Address - Fax:
Practice Address - Street 1:4700 KELLER HICKS RD
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76244-9663
Practice Address - Country:US
Practice Address - Phone:817-349-3898
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-12-29
Last Update Date:2015-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX202514106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist