Provider Demographics
NPI:1174008833
Name:HORACE BEACH PHD CALIFORNIA PROFESSIONAL PSYCHOLOGY CORPORATION
Entity Type:Organization
Organization Name:HORACE BEACH PHD CALIFORNIA PROFESSIONAL PSYCHOLOGY CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:HORACE
Authorized Official - Middle Name:
Authorized Official - Last Name:BEACH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:925-494-3366
Mailing Address - Street 1:1460 WASHINGTON BLVD STE C-6
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:CA
Mailing Address - Zip Code:94521-4048
Mailing Address - Country:US
Mailing Address - Phone:925-494-3366
Mailing Address - Fax:
Practice Address - Street 1:1460 WASHINGTON BLVD STE C-6
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:CA
Practice Address - Zip Code:94521-4048
Practice Address - Country:US
Practice Address - Phone:925-494-3366
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-09-28
Last Update Date:2018-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty