Provider Demographics
NPI:1285732891
Name:GOLDBECK, TANYA KAREN (LPC, LMFT)
Entity type:Individual
Prefix:DR
First Name:TANYA
Middle Name:KAREN
Last Name:GOLDBECK
Suffix:
Gender:F
Credentials:LPC, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2627 CALDER ST STE 200B
Mailing Address - Street 2:
Mailing Address - City:BEAUMONT
Mailing Address - State:TX
Mailing Address - Zip Code:77702-1916
Mailing Address - Country:US
Mailing Address - Phone:409-835-1375
Mailing Address - Fax:409-835-1770
Practice Address - Street 1:2627 CALDER ST STE 200B
Practice Address - Street 2:
Practice Address - City:BEAUMONT
Practice Address - State:TX
Practice Address - Zip Code:77702-1916
Practice Address - Country:US
Practice Address - Phone:409-835-1375
Practice Address - Fax:409-835-1770
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX3801101Y00000X
TX106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101Y00000XBehavioral Health & Social Service ProvidersCounselor
Not Answered106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX#7407LCOtherBCBS
TX#4613521OtherAETNA