Provider Demographics
NPI:1063921120
Name:BECKER, GENEVIEVE LOUISE
Entity type:Individual
Prefix:
First Name:GENEVIEVE
Middle Name:LOUISE
Last Name:BECKER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:132 NW 195TH ST
Mailing Address - Street 2:
Mailing Address - City:SHORELINE
Mailing Address - State:WA
Mailing Address - Zip Code:98177-2511
Mailing Address - Country:US
Mailing Address - Phone:559-804-4344
Mailing Address - Fax:
Practice Address - Street 1:132 NW 195TH ST
Practice Address - Street 2:
Practice Address - City:SHORELINE
Practice Address - State:WA
Practice Address - Zip Code:98177
Practice Address - Country:US
Practice Address - Phone:559-804-4344
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-09-21
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health