Healthcare Provider Details

I. General information

NPI: 1235057241
Provider Name (Legal Business Name): BEUCHOOSEU THERAPY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/07/2026
Last Update Date: 07/07/2026
Certification Date: 07/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16905 CRESTA DR
SAN DIEGO CA
92128-2309
US

IV. Provider business mailing address

16905 CRESTA DR
SAN DIEGO CA
92128-2309
US

V. Phone/Fax

Practice location:
  • Phone: 858-466-9786
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: KANDICE NELSON
Title or Position: OWNER
Credential: LPCC
Phone: 858-466-9786