Provider Demographics
NPI:1811670128
Name:DEREK C. BECKER LICENSED MARRIAGE AND FAMILY THERAPIST,
Entity type:Organization
Organization Name:DEREK C. BECKER LICENSED MARRIAGE AND FAMILY THERAPIST,
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:DEREK
Authorized Official - Middle Name:CHAD
Authorized Official - Last Name:BECKER
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:831-262-6292
Mailing Address - Street 1:10193 COMBIE RD STE 210
Mailing Address - Street 2:
Mailing Address - City:AUBURN
Mailing Address - State:CA
Mailing Address - Zip Code:95602-8976
Mailing Address - Country:US
Mailing Address - Phone:530-205-3042
Mailing Address - Fax:
Practice Address - Street 1:10193 COMBIE RD STE 210
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:CA
Practice Address - Zip Code:95602-8976
Practice Address - Country:US
Practice Address - Phone:530-205-3042
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-08-11
Last Update Date:2023-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty