Provider Demographics
NPI:1780341016
Name:BECKMAN, AMI BROOKE (TCADC, MSW)
Entity type:Individual
Prefix:
First Name:AMI
Middle Name:BROOKE
Last Name:BECKMAN
Suffix:
Gender:F
Credentials:TCADC, MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:229 CLOVER POINTE DR
Mailing Address - Street 2:
Mailing Address - City:SOMERSET
Mailing Address - State:KY
Mailing Address - Zip Code:42503-5802
Mailing Address - Country:US
Mailing Address - Phone:606-802-1083
Mailing Address - Fax:
Practice Address - Street 1:9245 W HIGHWAY 80
Practice Address - Street 2:
Practice Address - City:NANCY
Practice Address - State:KY
Practice Address - Zip Code:42544-8767
Practice Address - Country:US
Practice Address - Phone:606-288-0013
Practice Address - Fax:606-288-0013
Is Sole Proprietor?:No
Enumeration Date:2021-11-22
Last Update Date:2021-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY260519101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)