Provider Demographics
NPI:1669788105
Name:BECKER, RICKY LEE (LMSW, CSWA)
Entity type:Individual
Prefix:MR
First Name:RICKY
Middle Name:LEE
Last Name:BECKER
Suffix:
Gender:M
Credentials:LMSW, CSWA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:474 NE EMERSON AVE
Mailing Address - Street 2:
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97701-4939
Mailing Address - Country:US
Mailing Address - Phone:262-389-6778
Mailing Address - Fax:
Practice Address - Street 1:160 SW SCALE HSE LOOP
Practice Address - Street 2:SUITE 160
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97702-1284
Practice Address - Country:US
Practice Address - Phone:541-312-4316
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-22
Last Update Date:2015-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORM60521041C0700X
ORA60521041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical