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NPI Code Detail

MEDICARE: SPIRITUAL PSYCHOLOGIST PC

MEDICARE: SPIRITUAL PSYCHOLOGIST PC
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
1103T00000XPsychologist

General Provider Information

NPI Number : 1669906657
Entity Type Code : Organization
Provider Name (Legal Business Name) : SPIRITUAL PSYCHOLOGIST PC
Provider Business Mailing Address
First Line : PO BOX 1873
Second Line :
City : DISCOVERY BAY
State : CA
Zip : 94505-7873
Country : US
Telephone Number : 562-331-0978
Fax Number : 925-384-2372
Provider Business Practice Location Address
First Line : 5655 SCHOONER LOOP
Second Line :
City : DISCOVERY BAY
State : CA
Zip : 94505-9213
Country : US
Telephone Number : 562-331-0978
Fax Number : 925-384-2372
Authorized Official
Title or Position : PRESIDENT
Name : DR. MARIE BEECH
Credential : PSYD
Telephone Number : 562-331-0978
Provider Enumeration Date : 04/17/2017
Last Update Date : 04/09/2021

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