Provider Demographics
NPI:1811333172
Name:BECKHAM, BROOKE J (MSW, LCSW)
Entity type:Individual
Prefix:
First Name:BROOKE
Middle Name:J
Last Name:BECKHAM
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1231 BALDWIN AVE
Mailing Address - Street 2:
Mailing Address - City:CANON CITY
Mailing Address - State:CO
Mailing Address - Zip Code:81212-4927
Mailing Address - Country:US
Mailing Address - Phone:605-941-6660
Mailing Address - Fax:
Practice Address - Street 1:831 ROYAL GORGE BLVD STE 217
Practice Address - Street 2:
Practice Address - City:CANON CITY
Practice Address - State:CO
Practice Address - Zip Code:81212-6709
Practice Address - Country:US
Practice Address - Phone:719-221-8451
Practice Address - Fax:719-452-3752
Is Sole Proprietor?:No
Enumeration Date:2013-05-14
Last Update Date:2020-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD07111330101YA0400X
COACD0000646101YA0400X
SD29891041C0700X
COCSW.099236041041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)