Provider Demographics
NPI:1497221766
Name:BECKMAN, MICAH JEAN (LMSW)
Entity type:Individual
Prefix:
First Name:MICAH
Middle Name:JEAN
Last Name:BECKMAN
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:MICAH
Other - Middle Name:
Other - Last Name:BECKMAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LMSW
Mailing Address - Street 1:8865 PROFESSIONAL DR STE 3
Mailing Address - Street 2:
Mailing Address - City:CADILLAC
Mailing Address - State:MI
Mailing Address - Zip Code:49601-8627
Mailing Address - Country:US
Mailing Address - Phone:231-285-0005
Mailing Address - Fax:
Practice Address - Street 1:8865 PROFESSIONAL DR STE 3
Practice Address - Street 2:
Practice Address - City:CADILLAC
Practice Address - State:MI
Practice Address - Zip Code:49601-8627
Practice Address - Country:US
Practice Address - Phone:231-285-0005
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-15
Last Update Date:2024-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68011058451041C0700X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical