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NPI Code Detail

MEDICARE: DR. LINDSEY J BEAVEN PHD, MFT

MEDICARE: DR. LINDSEY J BEAVEN PHD, MFT
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1106H00000XMarriage & Family TherapistMFC 46826CA

General Provider Information

NPI Number : 1083066914
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. LINDSEY J BEAVEN PHD, MFT
Provider Business Mailing Address
First Line : PO BOX 9534
Second Line :
City : SAN RAFAEL
State : CA
Zip : 94912-9534
Country : US
Telephone Number : 415-902-1304
Fax Number :
Provider Business Practice Location Address
First Line : 15 AUSTIN AVE
Second Line :
City : SAN ANSELMO
State : CA
Zip : 94960-2924
Country : US
Telephone Number : 415-902-1304
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/03/2016
Last Update Date : 07/03/2016

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