Healthcare Provider Details

I. General information

NPI: 1295660843
Provider Name (Legal Business Name): FRESH MINDS PSYCHOLOGY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/16/2026
Last Update Date: 06/16/2026
Certification Date: 06/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2491 PURDUE AVE APT 217
LOS ANGELES CA
90064-5119
US

IV. Provider business mailing address

11270 EXPOSITION BLVD UNIT 64224
LOS ANGELES CA
90064-5904
US

V. Phone/Fax

Practice location:
  • Phone: 909-642-5540
  • Fax:
Mailing address:
  • Phone: 323-431-9747
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number State

VIII. Authorized Official

Name: DR. KAMERON DEPRE BECKETT
Title or Position: PSYCHOLOGIST
Credential:
Phone: 323-431-9747