Healthcare Provider Details

I. General information

NPI: 1033123385
Provider Name (Legal Business Name): LAUREN ELIZABETH BEAUCHAMP PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/29/2006
Last Update Date: 10/08/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3325 GREYSTONE DR
JAMUL CA
91935-1541
US

IV. Provider business mailing address

2452 FENTON ST SUITE 202
CHULA VISTA CA
91914-3599
US

V. Phone/Fax

Practice location:
  • Phone: 619-588-2680
  • Fax: 858-467-6933
Mailing address:
  • Phone: 858-279-1223
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSY19559
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: