Healthcare Provider Details

I. General information

NPI: 1407596240
Provider Name (Legal Business Name): INNER BEACON THERAPY, A LICENSED PROFESSIONAL CLINICAL COUNSELOR CO
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/30/2022
Last Update Date: 06/17/2026
Certification Date: 06/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5501 STOCKDALE HWY UNIT 11032
BAKERSFIELD CA
93389-7098
US

IV. Provider business mailing address

5501 STOCKDALE HWY UNIT 11032
BAKERSFIELD CA
93389-7098
US

V. Phone/Fax

Practice location:
  • Phone: 661-412-4291
  • Fax: 855-794-0970
Mailing address:
  • Phone: 661-412-4291
  • Fax: 855-794-0970

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: LEAH LOUISE LOPETEGUY
Title or Position: OWNER
Credential: LMFT, LPCC
Phone: 661-412-4291