Provider Demographics
NPI:1407955016
Name:BETH CORRICK MFT
Entity Type:Organization
Organization Name:BETH CORRICK MFT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MARRIAGE AND FAMILY THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:BETH
Authorized Official - Middle Name:
Authorized Official - Last Name:CORRICK
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:858-699-1497
Mailing Address - Street 1:PO BOX 1074
Mailing Address - Street 2:CARDIFF, CA 92007
Mailing Address - City:CARDIFF BY THE SEA
Mailing Address - State:CA
Mailing Address - Zip Code:92007-7074
Mailing Address - Country:US
Mailing Address - Phone:858-699-1497
Mailing Address - Fax:858-481-8271
Practice Address - Street 1:5752 OBERLIN DR STE 203
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92121-1749
Practice Address - Country:US
Practice Address - Phone:858-699-1497
Practice Address - Fax:858-481-8271
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-21
Last Update Date:2010-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC 46498302R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization