Provider Demographics
NPI:1154612216
Name:BECK, GINA M (LCSW)
Entity type:Individual
Prefix:
First Name:GINA
Middle Name:M
Last Name:BECK
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6451 MCCALL ST STE D
Mailing Address - Street 2:
Mailing Address - City:BONNERS FERRY
Mailing Address - State:ID
Mailing Address - Zip Code:83805-8525
Mailing Address - Country:US
Mailing Address - Phone:208-304-2657
Mailing Address - Fax:208-215-2473
Practice Address - Street 1:6451 MCCALL ST STE D
Practice Address - Street 2:
Practice Address - City:BONNERS FERRY
Practice Address - State:ID
Practice Address - Zip Code:83805-8525
Practice Address - Country:US
Practice Address - Phone:208-304-2657
Practice Address - Fax:208-215-2473
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-25
Last Update Date:2022-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS 184671041C0700X
IDLCSW 304431041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID1245528082Medicaid
1154612216OtherMEDICARE