Provider Demographics
NPI:1376921379
Name:MCEACHIN, CARA (LEP)
Entity Type:Individual
Prefix:
First Name:CARA
Middle Name:
Last Name:MCEACHIN
Suffix:
Gender:F
Credentials:LEP
Other - Prefix:
Other - First Name:CARA
Other - Middle Name:
Other - Last Name:YETZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1148 MASTEPEICE DRIVE
Mailing Address - Street 2:
Mailing Address - City:OCEANSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92057
Mailing Address - Country:US
Mailing Address - Phone:540-521-3972
Mailing Address - Fax:
Practice Address - Street 1:41856 IVY STREET
Practice Address - Street 2:SUITE 205
Practice Address - City:MURRIETA
Practice Address - State:CA
Practice Address - Zip Code:92562
Practice Address - Country:US
Practice Address - Phone:951-396-5701
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-05-11
Last Update Date:2022-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
222Q00000X
CA4268103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool
No222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist