Provider Demographics
NPI:1487136420
Name:BECKSTEAD, RYAN BRENT (LCSW)
Entity type:Individual
Prefix:
First Name:RYAN
Middle Name:BRENT
Last Name:BECKSTEAD
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:490 PARK AVE STE 4
Mailing Address - Street 2:
Mailing Address - City:IDAHO FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83402-1230
Mailing Address - Country:US
Mailing Address - Phone:208-612-5035
Mailing Address - Fax:208-612-5036
Practice Address - Street 1:490 PARK AVE STE 4
Practice Address - Street 2:
Practice Address - City:IDAHO FALLS
Practice Address - State:ID
Practice Address - Zip Code:83402-1230
Practice Address - Country:US
Practice Address - Phone:208-612-5035
Practice Address - Fax:208-612-5036
Is Sole Proprietor?:No
Enumeration Date:2018-09-06
Last Update Date:2018-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLCSW-380231041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical