Provider Demographics
NPI:1922271212
Name:BECK, KERRY J (LISW-SUPV)
Entity type:Individual
Prefix:MR
First Name:KERRY
Middle Name:J
Last Name:BECK
Suffix:
Gender:M
Credentials:LISW-SUPV
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:329 N WEST ST
Mailing Address - Street 2:
Mailing Address - City:LIMA
Mailing Address - State:OH
Mailing Address - Zip Code:45801-4331
Mailing Address - Country:US
Mailing Address - Phone:419-221-3072
Mailing Address - Fax:
Practice Address - Street 1:228 S MAIN ST
Practice Address - Street 2:
Practice Address - City:BRYAN
Practice Address - State:OH
Practice Address - Zip Code:43506-1755
Practice Address - Country:US
Practice Address - Phone:567-239-4562
Practice Address - Fax:419-225-8878
Is Sole Proprietor?:No
Enumeration Date:2008-04-08
Last Update Date:2024-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI.0700134-SUPV101YM0800X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health