Basic Information
| Provider Information | |||||||||
| NPI: | 1942418967 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BECKER | ||||||||
| FirstName: | SCOTT | ||||||||
| MiddleName: | HARRISON | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | PH.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4142 LEEWARD DR | ||||||||
| Address2: | |||||||||
| City: | OKEMOS | ||||||||
| State: | MI | ||||||||
| PostalCode: | 488644400 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5853509655 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 2127 UNIVERSITY PARK DR | ||||||||
| Address2: | |||||||||
| City: | OKEMOS | ||||||||
| State: | MI | ||||||||
| PostalCode: | 488645928 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8006931916 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/21/2007 | ||||||||
| LastUpdateDate: | 08/05/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 08/05/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103TC0700X | 017100 | NY | N | Behavioral Health & Social Service Providers | Psychologist | Clinical | 103TC0700X | 6301014519 | MI | Y | Behavioral Health & Social Service Providers | Psychologist | Clinical |
No ID Information.