Provider Demographics
NPI:1033123831
Name:LAND, JOAN BEVERLY (MS)
Entity Type:Individual
Prefix:MS
First Name:JOAN
Middle Name:BEVERLY
Last Name:LAND
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 9801
Mailing Address - Street 2:
Mailing Address - City:BREA
Mailing Address - State:CA
Mailing Address - Zip Code:92822-1801
Mailing Address - Country:US
Mailing Address - Phone:714-526-8433
Mailing Address - Fax:714-257-1017
Practice Address - Street 1:1370 BREA BLVD STE 144
Practice Address - Street 2:
Practice Address - City:FULLERTON
Practice Address - State:CA
Practice Address - Zip Code:92835-4123
Practice Address - Country:US
Practice Address - Phone:714-526-8433
Practice Address - Fax:714-257-1017
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC25272101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health