Healthcare Provider Details

I. General information

NPI: 1396862710
Provider Name (Legal Business Name): CHAD WAYNE BECKMAN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/22/2007
Last Update Date: 08/07/2026
Certification Date: 08/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

275 BAKER ST
COSTA MESA CA
92626-4566
US

IV. Provider business mailing address

275 BAKER ST STE A
COSTA MESA CA
92626-4566
US

V. Phone/Fax

Practice location:
  • Phone: 714-361-6760
  • Fax:
Mailing address:
  • Phone: 714-361-6760
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number42396
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: