Provider Demographics
NPI:1972756013
Name:BECKER-GIBEAU PSYCHOLOGICAL SERVICES, LLC
Entity type:Organization
Organization Name:BECKER-GIBEAU PSYCHOLOGICAL SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:MATTHEW
Authorized Official - Last Name:GIBEAU
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:262-377-2006
Mailing Address - Street 1:14135 N CEDARBURG RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:MEQUON
Mailing Address - State:WI
Mailing Address - Zip Code:53097-1416
Mailing Address - Country:US
Mailing Address - Phone:262-377-2006
Mailing Address - Fax:262-377-5552
Practice Address - Street 1:14135 N CEDARBURG RD
Practice Address - Street 2:SUITE 100
Practice Address - City:MEQUON
Practice Address - State:WI
Practice Address - Zip Code:53097-1416
Practice Address - Country:US
Practice Address - Phone:262-377-2006
Practice Address - Fax:262-377-5552
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-03
Last Update Date:2008-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2344-057103TC0700X
WI2330-057103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty