Provider Demographics
NPI:1669776720
Name:BECKWITH, LORI LOU (EDD)
Entity type:Individual
Prefix:MRS
First Name:LORI
Middle Name:LOU
Last Name:BECKWITH
Suffix:
Gender:F
Credentials:EDD
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 1096
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:IL
Mailing Address - Zip Code:62236-1096
Mailing Address - Country:US
Mailing Address - Phone:618-281-5777
Mailing Address - Fax:
Practice Address - Street 1:9 OLD KINGS RD N STE 1231113
Practice Address - Street 2:
Practice Address - City:PALM COAST
Practice Address - State:FL
Practice Address - Zip Code:32137-4603
Practice Address - Country:US
Practice Address - Phone:618-342-8466
Practice Address - Fax:706-813-8199
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-04
Last Update Date:2023-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH22468101YM0800X
MO2010021564101YP2500X
IL180.007683101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health