Healthcare Provider Details

I. General information

NPI: 1417831736
Provider Name (Legal Business Name): CALLEN BECK GORDON MA, AMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/31/2025
Last Update Date: 07/31/2025
Certification Date: 07/31/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4620A HOLLYWOOD BLVD
LOS ANGELES CA
90027-5408
US

IV. Provider business mailing address

12133 MARSHALL ST
CULVER CITY CA
90230-5829
US

V. Phone/Fax

Practice location:
  • Phone: 310-895-3034
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number155306
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: