Provider Demographics
NPI:1972099505
Name:BECKFORD, MELISSA L (MS)
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:L
Last Name:BECKFORD
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3031 LANGSTONE DR
Mailing Address - Street 2:
Mailing Address - City:ROCKFORD
Mailing Address - State:IL
Mailing Address - Zip Code:61109-1774
Mailing Address - Country:US
Mailing Address - Phone:214-434-9927
Mailing Address - Fax:
Practice Address - Street 1:136 W GRAND AVE STE 250
Practice Address - Street 2:
Practice Address - City:BELOIT
Practice Address - State:WI
Practice Address - Zip Code:53511-6273
Practice Address - Country:US
Practice Address - Phone:608-346-8315
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-06
Last Update Date:2018-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3835-226101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI3835-226Medicaid