Healthcare Provider Details

I. General information

NPI: 1912494352
Provider Name (Legal Business Name): GARY WAYNE MCBEATH DR
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/20/2018
Last Update Date: 04/20/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17821 E 17TH STREET SUITE # 260
TUSTIN CA
92780
US

IV. Provider business mailing address

17821 E 17TH STREET SUITE # 260
TUSTIN CA
92780
US

V. Phone/Fax

Practice location:
  • Phone: 714-730-7846
  • Fax: 714-265-4870
Mailing address:
  • Phone: 714-730-7846
  • Fax: 714-265-4870

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberMFC40195
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code102L00000X
TaxonomyPsychoanalyst
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: