Provider Demographics
NPI:1457704405
Name:SPOTTEN, BECKY L (CMHC, LPC)
Entity Type:Individual
Prefix:
First Name:BECKY
Middle Name:L
Last Name:SPOTTEN
Suffix:
Gender:F
Credentials:CMHC, LPC
Other - Prefix:
Other - First Name:BECKY
Other - Middle Name:L
Other - Last Name:GROVER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CMHC, LPC
Mailing Address - Street 1:274 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:LOGAN
Mailing Address - State:UT
Mailing Address - Zip Code:84321-3915
Mailing Address - Country:US
Mailing Address - Phone:435-200-5507
Mailing Address - Fax:
Practice Address - Street 1:274 N MAIN ST
Practice Address - Street 2:
Practice Address - City:LOGAN
Practice Address - State:UT
Practice Address - Zip Code:84321-3915
Practice Address - Country:US
Practice Address - Phone:435-200-5507
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-07-14
Last Update Date:2021-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLPC-6808101YP2500X
WYLPC-1862101YP2500X
WYPPC-1001101YP2500X
UT11243997-6004101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional