Provider Demographics
NPI:1992105522
Name:BECK, TAMMI LYNN (MA, EDS)
Entity type:Individual
Prefix:MS
First Name:TAMMI
Middle Name:LYNN
Last Name:BECK
Suffix:
Gender:F
Credentials:MA, EDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:961 S 50 W
Mailing Address - Street 2:
Mailing Address - City:BURLEY
Mailing Address - State:ID
Mailing Address - Zip Code:83318-5610
Mailing Address - Country:US
Mailing Address - Phone:208-312-2626
Mailing Address - Fax:
Practice Address - Street 1:961 S 50 W
Practice Address - Street 2:
Practice Address - City:BURLEY
Practice Address - State:ID
Practice Address - Zip Code:83318-5610
Practice Address - Country:US
Practice Address - Phone:208-312-2626
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-02
Last Update Date:2014-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool