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General NPI Number Information
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NPI Number | 1588671432
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Entity Type | Individual
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Provider Name | PAT M BEAUPRE PHD
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Gender | Female
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Dates
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Enumeration Date | 08/02/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 511 BROOKSIDE AVE
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City | REDLANDS
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State | CA
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Zip | 92373-4611
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Country | US
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Telephone | 909-335-6005
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Fax | 909-335-8514
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Provider Business Mailing Address
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Address Line | PO BOX 293
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City | BRYN MAWR
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State | CA
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Zip | 92318-0293
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Country | US
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Telephone | 909-335-6005
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Fax | 909-335-8514
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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 | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | PSY 14953
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License Number State | CA
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