Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YP1600X | Pastoral Counselor |
NPI | 1043456981 |
---|---|
Provider Name | Dr. Jacky Beck |
First Address | Gadsden, AL 35901-5370 |
Second Address | Gadsden, AL 35901-5370 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 24/12/2008 |
Last Update Date | 24/12/2008 |