Provider Demographics
NPI:1740953348
Name:BECKER, MARIAN REBECCA (BECKY)
Entity type:Individual
Prefix:
First Name:MARIAN
Middle Name:REBECCA (BECKY)
Last Name:BECKER
Suffix:
Gender:F
Credentials:
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 2471
Mailing Address - Street 2:
Mailing Address - City:GUYMON
Mailing Address - State:OK
Mailing Address - Zip Code:73942-2471
Mailing Address - Country:US
Mailing Address - Phone:580-527-1147
Mailing Address - Fax:
Practice Address - Street 1:310 N LELIA ST
Practice Address - Street 2:
Practice Address - City:GUYMON
Practice Address - State:OK
Practice Address - Zip Code:73942-4829
Practice Address - Country:US
Practice Address - Phone:580-527-1147
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-29
Last Update Date:2021-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
OKBBECKER1Medicaid