Provider Demographics
NPI:1497884498
Name:BECKER, NICOLE (PSYD)
Entity type:Individual
Prefix:DR
First Name:NICOLE
Middle Name:
Last Name:BECKER
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:794 EASTLAND DR
Mailing Address - Street 2:
Mailing Address - City:TWIN FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83301-6856
Mailing Address - Country:US
Mailing Address - Phone:208-734-3312
Mailing Address - Fax:208-933-4435
Practice Address - Street 1:2647 KIMBERLY RD STE 2
Practice Address - Street 2:
Practice Address - City:TWIN FALLS
Practice Address - State:ID
Practice Address - Zip Code:83301-7976
Practice Address - Country:US
Practice Address - Phone:208-734-1281
Practice Address - Fax:208-933-4435
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-05
Last Update Date:2024-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID7671932103T00000X
101YM0800X
CAPSY26010103T00000X
CA26010103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health