Provider Demographics
NPI:1700950508
Name:BECK, MOLLIE DUGAN (MS)
Entity type:Individual
Prefix:MRS
First Name:MOLLIE
Middle Name:DUGAN
Last Name:BECK
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1770 PACIFIC AVE
Mailing Address - Street 2:
Mailing Address - City:CAYUCOS
Mailing Address - State:CA
Mailing Address - Zip Code:93430-1606
Mailing Address - Country:US
Mailing Address - Phone:805-704-9727
Mailing Address - Fax:805-995-2383
Practice Address - Street 1:3556 EL CAMINO REAL
Practice Address - Street 2:
Practice Address - City:ATASCADERO
Practice Address - State:CA
Practice Address - Zip Code:93422
Practice Address - Country:US
Practice Address - Phone:805-461-6157
Practice Address - Fax:805-461-6114
Is Sole Proprietor?:No
Enumeration Date:2006-11-20
Last Update Date:2015-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA43425106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1548479686OtherSAN LUIS OBISPO DRUG AND ALCOHOL SERVICES, ATASCADERO, CA 93422