Provider Demographics
NPI:1083066914
Name:BEAVEN, LINDSEY J (PHD, MFT)
Entity Type:Individual
Prefix:DR
First Name:LINDSEY
Middle Name:J
Last Name:BEAVEN
Suffix:
Gender:F
Credentials:PHD, MFT
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 9534
Mailing Address - Street 2:
Mailing Address - City:SAN RAFAEL
Mailing Address - State:CA
Mailing Address - Zip Code:94912-9534
Mailing Address - Country:US
Mailing Address - Phone:415-902-1304
Mailing Address - Fax:
Practice Address - Street 1:15 AUSTIN AVE
Practice Address - Street 2:
Practice Address - City:SAN ANSELMO
Practice Address - State:CA
Practice Address - Zip Code:94960-2924
Practice Address - Country:US
Practice Address - Phone:415-902-1304
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-03
Last Update Date:2016-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC 46826106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist