Provider Demographics
NPI:1083026686
Name:BEAKEY, MICHELLE
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:
Last Name:BEAKEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1920 HILLHURST AVE
Mailing Address - Street 2:# 264
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90027-2712
Mailing Address - Country:US
Mailing Address - Phone:214-770-8270
Mailing Address - Fax:
Practice Address - Street 1:3401 GLENDALE BLVD
Practice Address - Street 2:STE B
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90039-1814
Practice Address - Country:US
Practice Address - Phone:323-400-5650
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-05-30
Last Update Date:2020-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSB94020517103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist