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NPI Code Detail

MEDICARE: TRACY BEVINGTON MFT

MEDICARE: TRACY BEVINGTON MFT
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YM0800XMental Health Counselor53455CA

General Provider Information

NPI Number : 1548663800
Entity Type Code : Organization
Provider Name (Legal Business Name) : TRACY BEVINGTON MFT
Provider Business Mailing Address
First Line : 1230 ROSECRANS AVE STE 300
Second Line :
City : MANHATTAN BEACH
State : CA
Zip : 90266-2494
Country : US
Telephone Number : 310-226-2826
Fax Number : 310-943-2590
Provider Business Practice Location Address
First Line : 1230 ROSECRANS AVE STE 300
Second Line :
City : MANHATTAN BEACH
State : CA
Zip : 90266-2494
Country : US
Telephone Number : 310-226-2826
Fax Number : 310-943-2590
Authorized Official
Title or Position : MARRIAGE & FAMILY THERAPIST
Name : TRACY KOVACS BEVINGTON
Credential : MA MFT
Telephone Number : 310-226-2826
Provider Enumeration Date : 10/01/2014
Last Update Date : 10/01/2014

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Directions to “TRACY BEVINGTON MFT ” Practice Location

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