Provider Demographics
NPI:1285959189
Name:BECKNER, MICHAEL LEE (LMFT)
Entity type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:LEE
Last Name:BECKNER
Suffix:
Gender:M
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:8939 E STOCKTON BLVD
Mailing Address - Street 2:FBCEG
Mailing Address - City:ELK GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:95624-9492
Mailing Address - Country:US
Mailing Address - Phone:916-230-5945
Mailing Address - Fax:916-686-0974
Practice Address - Street 1:8939 E STOCKTON BLVD
Practice Address - Street 2:FBCEG
Practice Address - City:ELK GROVE
Practice Address - State:CA
Practice Address - Zip Code:95624-9492
Practice Address - Country:US
Practice Address - Phone:916-230-5945
Practice Address - Fax:916-686-0974
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-02
Last Update Date:2014-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CASC 82671101YS0200X
CA43050106H00000X
CA878101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA429839OtherMHN HEALTH NET
11931935OtherCAQH