Healthcare Provider Details

I. General information

NPI: 1275437519
Provider Name (Legal Business Name): RAYVEN BECKMANN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/07/2026
Last Update Date: 10/07/2026
Certification Date: 10/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

609 S GOLD ST
YREKA CA
96097-3110
US

IV. Provider business mailing address

210 3RD ST
YREKA CA
96097-2432
US

V. Phone/Fax

Practice location:
  • Phone: 559-794-0385
  • Fax:
Mailing address:
  • Phone: 559-794-0385
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number260152996
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: