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General NPI Number Information
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NPI Number | 1043899081
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Entity Type | Individual
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Provider Name | CHARLOTTE LACE BEARD PHD
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Gender | Female
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Dates
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Enumeration Date | 04/06/2021
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Last Update Date | 08/16/2024
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Provider Practice Location Address
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Address Line | 31831 CAMINO CAPISTRANO STE 111
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City | SAN JUAN CAPISTRANO
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State | CA
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Zip | 92675-3220
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Country | US
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Telephone | 669-210-2563
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Fax | 949-264-9261
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Provider Business Mailing Address
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Address Line | 31831 CAMINO CAPISTRANO STE 111
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City | SAN JUAN CAPISTRANO
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State | CA
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Zip | 92675-3220
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Country | US
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Telephone | 669-210-2563
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Fax | 949-264-9261
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | 32466
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License Number State | CA
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