Healthcare Provider Details

I. General information

NPI: 1467424721
Provider Name (Legal Business Name): JOHN PAUL BEAUDOIN M.DIV.,PH.D.,Q.M.E.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/02/2006
Last Update Date: 04/07/2026
Certification Date: 04/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

PO BOX 746
PEBBLE BEACH CA
93953-0746
US

IV. Provider business mailing address

PO BOX 746
PEBBLE BEACH CA
93953-0746
US

V. Phone/Fax

Practice location:
  • Phone: 831-648-0845
  • Fax: 831-665-5351
Mailing address:
  • Phone: 831-648-0845
  • Fax: 831-665-5351

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSY13842
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code103TF0200X
TaxonomyForensic Psychologist
License Number935452
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: