Healthcare Provider Details

I. General information

NPI: 1396862710
Provider Name (Legal Business Name): CHAD WAYNE BECKMAN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/22/2007
Last Update Date: 10/04/2024
Certification Date: 10/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

615 W CIVIC CENTER DR
SANTA ANA CA
92701-4006
US

IV. Provider business mailing address

615 W CIVIC CENTER DR STE 200
SANTA ANA CA
92701-4052
US

V. Phone/Fax

Practice location:
  • Phone: 714-795-3444
  • Fax:
Mailing address:
  • Phone: 714-795-3444
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number42396
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: