Individual
RYAN BRENT BECKSTEAD
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LCSW
Contact information
Practice address
490 PARK AVE STE 4, IDAHO FALLS, ID 83402-1230
(208) 612-5035
(208) 612-5036
Mailing address
490 PARK AVE STE 4, IDAHO FALLS, ID 83402-1230
(208) 612-5035
(208) 612-5036
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
LCSW-38023
ID
Other
Enumeration date
09/06/2018
Last updated
09/06/2018
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