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DR. JOHN PAUL BEAUDOIN M.DIV.,PH.D.,Q.M.E.
Clinical >> Psychologist >> Behavioral Health & Social Service ProvidersRegistrant NPI Number: 1467424721
Individual Registrant:DR. JOHN PAUL BEAUDOIN M.DIV.,PH.D.,Q.M.E.
Gender: M
Sole Proprietor
Gender: M
Sole Proprietor
Location and contact information for practice:
542 PI NE AVENUE A PACIFIC GROVE, CA 93950-3082 US
Tel: 831-648-0845 Fax: 831-642-9831
Tel: 831-648-0845 Fax: 831-642-9831
Contact information for business:
542 PINE AVE A PACIFIC GROVE, CA 93950-3443 US
Tel: 831-648-0845 Fax: 831-642-9831
Tel: 831-648-0845 Fax: 831-642-9831
Registration Information:
NPI: 1467424721
Entity Type: Individual
Entity Type: Individual
Specialty information:
| Primary | Code | Category/Description | State | License Number |
|---|---|---|---|---|
| Y | 103TC0700X | Behavioral Health & Social Service Providers Psychologist Clinical | CA | PSY13842 |
| N | 103TF0200X | Behavioral Health & Social Service Providers Psychologist | CA | 935452 |
Legacy codes, insurance codes and state license numbers:
| Issuer | Number | State | Type |
|---|---|---|---|
| QUAILIFIED MEDICAL EXAMIN | 935452 | CA | 01 |
| PSYCHOLOGY LIC. | PSY13842 | CA | 01 |
| PROVIDER NUMBER | OPL138420 | CA | 01 |
