Provider Demographics
NPI:1194063115
Name:BECKER, EMILY S (PC, MFT)
Entity type:Individual
Prefix:
First Name:EMILY
Middle Name:S
Last Name:BECKER
Suffix:
Gender:F
Credentials:PC, MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1084 S MAIN ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:BOWLING GREEN
Mailing Address - State:OH
Mailing Address - Zip Code:43402-4740
Mailing Address - Country:US
Mailing Address - Phone:419-352-4624
Mailing Address - Fax:
Practice Address - Street 1:1084 S MAIN ST
Practice Address - Street 2:SUITE A
Practice Address - City:BOWLING GREEN
Practice Address - State:OH
Practice Address - Zip Code:43402-4740
Practice Address - Country:US
Practice Address - Phone:419-352-4624
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-25
Last Update Date:2013-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHC.1100334101YP2500X
OHM.1300001106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist