Provider Demographics
NPI:1780494377
Name:BECKER, LISA NOELLE (MA)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:NOELLE
Last Name:BECKER
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:215 COLLEGE AVE
Mailing Address - Street 2:
Mailing Address - City:WEBSTER GROVES
Mailing Address - State:MO
Mailing Address - Zip Code:63119-1631
Mailing Address - Country:US
Mailing Address - Phone:314-307-1597
Mailing Address - Fax:
Practice Address - Street 1:2362 COUNTRY RD
Practice Address - Street 2:
Practice Address - City:SHILOH
Practice Address - State:IL
Practice Address - Zip Code:62221-2570
Practice Address - Country:US
Practice Address - Phone:773-659-9207
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-07
Last Update Date:2025-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes102L00000XBehavioral Health & Social Service ProvidersPsychoanalyst