Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 103TA0400X | Addiction Psychologist (Substance Use Disorder) | PSB94020449 | CA |
Y | 103G00000X | Clinical Psychologist | PSB94020449 | CA |
Y | 103TC0700X | Clinical Psychologist | PSB94020449 | CA |
N | 103TC1900X | Counseling Psychologist | PSB94020449 | CA |
N | 103TC2200X | Clinical Child & Adolescent Psychologist | PSB94020449 | CA |
N | 103TF0000X | Family Psychologist | PSB94020449 | CA |
NPI | 1104237833 |
---|---|
Provider Name | Dr. Kristin Lee Beasley |
First Address | Fresno, CA 93703-4817 |
Second Address | Fresno, CA 93703-4817 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/05/2014 |
Last Update Date | 15/05/2014 |