Provider Demographics
NPI:1992436000
Name:BECK BEHAVIOR THERAPY AND CONSULTATION
Entity type:Organization
Organization Name:BECK BEHAVIOR THERAPY AND CONSULTATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KELLI
Authorized Official - Middle Name:MICHELLE
Authorized Official - Last Name:BECK
Authorized Official - Suffix:
Authorized Official - Credentials:BCBA, LBA, MS ED
Authorized Official - Phone:229-854-1545
Mailing Address - Street 1:156 RIDGECREST LOOP
Mailing Address - Street 2:
Mailing Address - City:DOTHAN
Mailing Address - State:AL
Mailing Address - Zip Code:36301-6048
Mailing Address - Country:US
Mailing Address - Phone:229-854-1545
Mailing Address - Fax:
Practice Address - Street 1:2363 S BRANNON STAND RD
Practice Address - Street 2:
Practice Address - City:DOTHAN
Practice Address - State:AL
Practice Address - Zip Code:36305-7005
Practice Address - Country:US
Practice Address - Phone:334-618-6809
Practice Address - Fax:334-801-0516
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-06-20
Last Update Date:2022-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Multi-Specialty
No106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior AnalystGroup - Multi-Specialty
No106S00000XBehavioral Health & Social Service ProvidersBehavior TechnicianGroup - Multi-Specialty