MEDICARE: FRESH MINDS PSYCHOLOGY INC

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	103TC0700X	Clinical Psychologist

General Provider Information

NPI Number	:	1295660843
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FRESH MINDS PSYCHOLOGY INC

Provider Business Mailing Address
First Line	:	11270 EXPOSITION BLVD UNIT 64224
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90064-5904
Country	:	US
Telephone Number	:	323-431-9747
Fax Number	:

Provider Business Practice Location Address
First Line	:	2491 PURDUE AVE APT 217
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90064-5119
Country	:	US
Telephone Number	:	909-642-5540
Fax Number	:

Authorized Official
Title or Position	:	PSYCHOLOGIST
Name	:	DR. KAMERON DEPRE BECKETT
Credential	:
Telephone Number	:	323-431-9747

Provider Enumeration Date	:	06/16/2026
Last Update Date	:	06/16/2026

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