Healthcare Provider Details

I. General information

NPI: 1093661951
Provider Name (Legal Business Name): ERIC D BEADLE
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/04/2026
Last Update Date: 03/04/2026
Certification Date: 03/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3300 VIA MARINA AVE
OXNARD CA
93035-2440
US

IV. Provider business mailing address

4240 HARBOR BLVD APT 308
OXNARD CA
93035-4374
US

V. Phone/Fax

Practice location:
  • Phone: 805-385-1501
  • Fax:
Mailing address:
  • Phone: 805-385-1501
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: