Provider Demographics
NPI:1801467469
Name:BECK, MANDY E (MA, LPC)
Entity type:Individual
Prefix:
First Name:MANDY
Middle Name:E
Last Name:BECK
Suffix:
Gender:F
Credentials:MA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:851 W MONTROSE AVE # 210
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60613-1408
Mailing Address - Country:US
Mailing Address - Phone:773-431-1686
Mailing Address - Fax:
Practice Address - Street 1:405 N WABASH AVE UNIT 1114
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60611-3597
Practice Address - Country:US
Practice Address - Phone:224-999-1281
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-06
Last Update Date:2021-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL178.013985101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty