Provider Demographics
NPI:1871561027
Name:BECKHAM, ERNEST EDWARD (PHD)
Entity type:Individual
Prefix:
First Name:ERNEST
Middle Name:EDWARD
Last Name:BECKHAM
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4601 N CLASSEN BLVD
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73118-4815
Mailing Address - Country:US
Mailing Address - Phone:405-840-9999
Mailing Address - Fax:405-840-9998
Practice Address - Street 1:4601 N CLASSEN BLVD
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73118-4815
Practice Address - Country:US
Practice Address - Phone:405-840-9999
Practice Address - Fax:405-840-9998
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-14
Last Update Date:2013-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK317103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100841560AMedicaid
OK100841560AMedicaid