Doctor Name: | MS. LORI MARIE CARGEN BECKWITH |
NPI Number: | 1033436167 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | LADC |
License Number: | 302856 |
Business Practice Address: | 11400 Julianne Ave N Stillwater, MN - 550829436 |
Business Phone Number: | 6124542406 |
Business Fax Number: | 6514260419 |
Mailing Address: | 11400 Julianne Ave N, STILLWATER |
State: | MN |
Postal Code: | 550829436 |
Phone Number: | 6124542406 |
Fax Number: | 6514260419 |
NPI Enumeration Date: | 04/29/2010 |
NPI Last Update Date: | 07/22/2014 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YA0400X |
License Number: | 302856 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | MN |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Addiction (Substance Use Disorder) |
Taxonomy Definition: |