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NPI Code Detail

MEDICARE: HEAVEN BEAM-LONGWELL

MEDICARE: HEAVEN BEAM-LONGWELL
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 Therapist144223CA

General Provider Information

NPI Number : 1093350910
Entity Type Code : Individual
Provider Name (Legal Business Name) : HEAVEN BEAM-LONGWELL
Provider Business Mailing Address
First Line : 21825 ERWIN ST STE 1062
Second Line :
City : WOODLAND HILLS
State : CA
Zip : 91367-3610
Country : US
Telephone Number : 424-527-8100
Fax Number :
Provider Business Practice Location Address
First Line : 1691 GRAMERCY AVE
Second Line :
City : TORRANCE
State : CA
Zip : 90501-3236
Country : US
Telephone Number : 714-617-4886
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/14/2019
Last Update Date : 10/13/2025

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Directions to “ HEAVEN BEAM-LONGWELL ” Practice Location

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