Provider Demographics
NPI:1104693431
Name:BECKHAM, ROBERT MATTHEW (LMHC, NCC)
Entity type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:MATTHEW
Last Name:BECKHAM
Suffix:
Gender:
Credentials:LMHC, NCC
Other - Prefix:
Other - First Name:ROBERT
Other - Middle Name:MATTHEW
Other - Last Name:ALTIZER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1133 LOUISIANA AVE STE 208
Mailing Address - Street 2:
Mailing Address - City:WINTER PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32789-2350
Mailing Address - Country:US
Mailing Address - Phone:407-617-3409
Mailing Address - Fax:
Practice Address - Street 1:1133 LOUISIANA AVE STE 208
Practice Address - Street 2:
Practice Address - City:WINTER PARK
Practice Address - State:FL
Practice Address - Zip Code:32789-2350
Practice Address - Country:US
Practice Address - Phone:407-617-3409
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-12-06
Last Update Date:2025-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH24817101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health