Healthcare Provider Details

I. General information

NPI: 1316689755
Provider Name (Legal Business Name): AMY VANBECELAERE LPCC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/07/2022
Last Update Date: 04/07/2022
Certification Date: 04/07/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3434 VIA LIDO STE 200
NEWPORT BEACH CA
92663-3967
US

IV. Provider business mailing address

3434 VIA LIDO STE 200
NEWPORT BEACH CA
92663-3967
US

V. Phone/Fax

Practice location:
  • Phone: 949-386-8224
  • Fax:
Mailing address:
  • Phone: 949-633-2821
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLPCC9784
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code225600000X
TaxonomyDance Therapist
License NumberR-DMT-2067
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: