Healthcare Provider Details

I. General information

NPI: 1588412563
Provider Name (Legal Business Name): BEYOND HEALTHCARE HOLDINGS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/07/2024
Last Update Date: 05/07/2024
Certification Date: 05/07/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16885 PACIFIC COAST HWY UNIT 1358
SUNSET BEACH CA
90742-1871
US

IV. Provider business mailing address

16885 PACIFIC COAST HWY UNIT 1358
SUNSET BEACH CA
90742-1871
US

V. Phone/Fax

Practice location:
  • Phone: 949-735-0023
  • Fax:
Mailing address:
  • Phone: 949-735-0023
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code103TF0200X
TaxonomyForensic Psychologist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QC1800X
TaxonomyCorporate Health Clinic/Center
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code261QI0500X
TaxonomyInfusion Therapy Clinic/Center
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State
# 6
Primary TaxonomyY
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. STEPHEN ODOM
Title or Position: CEO
Credential: PHD
Phone: 949-735-0023