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General NPI Number Information
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NPI Number | 1083026686
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Entity Type | Individual
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Provider Name | MICHELLE BEAKEY
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Gender | Female
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Dates
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Enumeration Date | 05/30/2014
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Last Update Date | 11/02/2020
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Provider Practice Location Address
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Address Line | 3401 GLENDALE BLVD STE B
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City | LOS ANGELES
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State | CA
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Zip | 90039-1814
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Country | US
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Telephone | 323-400-5650
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Fax |
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Provider Business Mailing Address
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Address Line | 1920 HILLHURST AVE # 264
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City | LOS ANGELES
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State | CA
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Zip | 90027-2712
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Country | US
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Telephone | 214-770-8270
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Fax |
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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 | PSB94020517
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License Number State | CA
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