Provider Demographics
NPI:1700134582
Name:BECK, LAURA MARIE (LMT,MMP,WSI)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:MARIE
Last Name:BECK
Suffix:
Gender:F
Credentials:LMT,MMP,WSI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3405 SHANNON PL
Mailing Address - Street 2:
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32504-4480
Mailing Address - Country:US
Mailing Address - Phone:850-293-9602
Mailing Address - Fax:
Practice Address - Street 1:3405 SHANNON PL
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32504-4480
Practice Address - Country:US
Practice Address - Phone:850-293-9602
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-27
Last Update Date:2012-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA61528175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath