Basic Information
| Provider Information | |||||||||
| NPI: | 1871172759 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BECCACIO | ||||||||
| FirstName: | JULIE | ||||||||
| MiddleName: | |||||||||
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| Credential: | LPT | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 607 | ||||||||
| Address2: | |||||||||
| City: | BLUE LAKE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 955250607 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7076302466 | ||||||||
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| Practice Location | |||||||||
| Address1: | 720 WOOD ST | ||||||||
| Address2: | |||||||||
| City: | EUREKA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 955014413 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7072682990 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/07/2021 | ||||||||
| LastUpdateDate: | 04/07/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 04/07/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 167G00000X | 36299 | CA | Y | Nursing Service Providers | Licensed Psychiatric Technician |
No ID Information.