Provider Demographics
NPI:1265139141
Name:BECK, MINDY LYNN (PMHNP-BC)
Entity type:Individual
Prefix:
First Name:MINDY
Middle Name:LYNN
Last Name:BECK
Suffix:
Gender:
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1950 W HEATHERBRAE DR STE 10-1
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85015-5110
Mailing Address - Country:US
Mailing Address - Phone:480-708-4125
Mailing Address - Fax:602-336-5160
Practice Address - Street 1:1950 W HEATHERBRAE DR STE 10-1
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85015-5110
Practice Address - Country:US
Practice Address - Phone:480-708-4125
Practice Address - Fax:602-443-0231
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-13
Last Update Date:2025-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ2023000230363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ2023000230OtherANCC ID