MEDICARE: STACEY BECKERLEY

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
1	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1104609742
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STACEY BECKERLEY

Provider Business Mailing Address
First Line	:	3620 MOUNT ABBEY AVE
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92111-4004
Country	:	US
Telephone Number	:	619-865-6737
Fax Number	:

Provider Business Practice Location Address
First Line	:	3620 MOUNT ABBEY AVE
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92111-4004
Country	:	US
Telephone Number	:	619-865-6737
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/16/2023
Last Update Date	:	08/21/2023

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Directions to “ STACEY BECKERLEY ” Practice Location

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