Provider Demographics
NPI:1245470277
Name:BECKHAM, MELISSIA ELAINE (LCSW)
Entity type:Individual
Prefix:
First Name:MELISSIA
Middle Name:ELAINE
Last Name:BECKHAM
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 10757
Mailing Address - Street 2:
Mailing Address - City:KILLEEN
Mailing Address - State:TX
Mailing Address - Zip Code:76547-0757
Mailing Address - Country:US
Mailing Address - Phone:254-415-7989
Mailing Address - Fax:254-699-7309
Practice Address - Street 1:2201 S W S YOUNG DR STE 117A1
Practice Address - Street 2:
Practice Address - City:KILLEEN
Practice Address - State:TX
Practice Address - Zip Code:76543-5338
Practice Address - Country:US
Practice Address - Phone:254-415-7989
Practice Address - Fax:254-699-7309
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-04
Last Update Date:2017-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX34547104100000X, 251B00000X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
No251B00000XAgenciesCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX2140832-01Medicaid