Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XM0800X | Mental Health | 2021028298 | MO |
NPI | 1578136362 |
---|---|
Provider Name | Mr. Jared Thomas Beck |
First Address | Lees Summit, MO 64064-2498 |
Second Address | Harrisonville, MO 64701 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/07/2021 |
Last Update Date | 01/12/2021 |