Provider Demographics
NPI:1457689416
Name:BEAUMONT, JEANNINE MARIE (MFT, ATR)
Entity Type:Individual
Prefix:
First Name:JEANNINE
Middle Name:MARIE
Last Name:BEAUMONT
Suffix:
Gender:F
Credentials:MFT, ATR
Other - Prefix:
Other - First Name:JEANNIE
Other - Middle Name:
Other - Last Name:BEAUMONT
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MFT, ATR
Mailing Address - Street 1:PO BOX 3645
Mailing Address - Street 2:
Mailing Address - City:REDONDO BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90277-1645
Mailing Address - Country:US
Mailing Address - Phone:310-543-9377
Mailing Address - Fax:310-543-9308
Practice Address - Street 1:1926 S PACIFIC COAST HWY
Practice Address - Street 2:SUITE 201
Practice Address - City:REDONDO BEACH
Practice Address - State:CA
Practice Address - Zip Code:90277-6119
Practice Address - Country:US
Practice Address - Phone:310-543-9377
Practice Address - Fax:310-543-9308
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-01
Last Update Date:2010-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC 47817106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist