Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TC1900X | Counseling Psychologist | 24970 | CA |
NPI | 1033776810 |
---|---|
Provider Name | Dr. Craig Beeson |
First Address | Soquel, CA 95073-9607 |
Second Address | Santa Cruz, CA 95060-4369 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 28/05/2019 |
Last Update Date | 28/06/2019 |