Doctor Name: | MR. MARLIN JAY BECKSTEAD |
NPI Number: | 1053631721 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | |
License Number: | |
Business Practice Address: | 68 S 600 E Slc, UT - 841021007 |
Business Phone Number: | 8013221001 |
Business Fax Number: | |
Mailing Address: | 344 E 100 S, SLC |
State: | UT |
Postal Code: | 841111700 |
Phone Number: | 8014283447 |
Fax Number: | |
NPI Enumeration Date: | 06/04/2010 |
NPI Last Update Date: | 06/04/2010 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YA0400X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Addiction (Substance Use Disorder) |
Taxonomy Definition: |