Provider Demographics
NPI:1972323525
Name:BECK, BRENT J (EDS, NCSP)
Entity type:Individual
Prefix:
First Name:BRENT
Middle Name:J
Last Name:BECK
Suffix:
Gender:M
Credentials:EDS, NCSP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1216 S INDIANA AVE
Mailing Address - Street 2:
Mailing Address - City:GOSHEN
Mailing Address - State:IN
Mailing Address - Zip Code:46526-7298
Mailing Address - Country:US
Mailing Address - Phone:574-533-3151
Mailing Address - Fax:
Practice Address - Street 1:1730 REGENT ST
Practice Address - Street 2:
Practice Address - City:GOSHEN
Practice Address - State:IN
Practice Address - Zip Code:46526-6305
Practice Address - Country:US
Practice Address - Phone:574-534-4710
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-16
Last Update Date:2024-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool