Provider Demographics
NPI:1962894881
Name:BECKETT, STEPHANI
Entity type:Individual
Prefix:
First Name:STEPHANI
Middle Name:
Last Name:BECKETT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:STEPHANI
Other - Middle Name:
Other - Last Name:BECKETT
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PLPC
Mailing Address - Street 1:500 W 6TH ST
Mailing Address - Street 2:
Mailing Address - City:APPLETON CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64724-1434
Mailing Address - Country:US
Mailing Address - Phone:417-448-4462
Mailing Address - Fax:
Practice Address - Street 1:500 W 6TH ST
Practice Address - Street 2:
Practice Address - City:APPLETON CITY
Practice Address - State:MO
Practice Address - Zip Code:64724-1434
Practice Address - Country:US
Practice Address - Phone:417-448-4462
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-03-02
Last Update Date:2015-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2015006039101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health