Provider Demographics
NPI:1962514208
Name:BECKLEY, PAULA SUE (MSW)
Entity type:Individual
Prefix:
First Name:PAULA
Middle Name:SUE
Last Name:BECKLEY
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1517 FOUNTAIN DR
Mailing Address - Street 2:
Mailing Address - City:LAWRENCE
Mailing Address - State:KS
Mailing Address - Zip Code:66047-9306
Mailing Address - Country:US
Mailing Address - Phone:785-331-9824
Mailing Address - Fax:
Practice Address - Street 1:901 KENTUCKY ST
Practice Address - Street 2:SUITE 301
Practice Address - City:LAWRENCE
Practice Address - State:KS
Practice Address - Zip Code:66044-2823
Practice Address - Country:US
Practice Address - Phone:785-331-9824
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2017-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS11621041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS130519Medicare ID - Type UnspecifiedPROIDER NUMBER