Healthcare Provider Details

I. General information

NPI: 1962634840
Provider Name (Legal Business Name): JEFFREY BEAL
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/11/2009
Last Update Date: 09/10/2026
Certification Date: 09/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

150 GRAND AVE STE 200
OAKLAND CA
94612-3726
US

IV. Provider business mailing address

150 GRAND AVE STE 200
OAKLAND CA
94612-3726
US

V. Phone/Fax

Practice location:
  • Phone: 510-923-1099
  • Fax: 510-903-7509
Mailing address:
  • Phone: 510-923-1099
  • Fax: 510-903-7509

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number92582
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number68533
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: