Provider Demographics
NPI:1578881256
Name:BEARDSLEY, SCOTT K (MA, MFT)
Entity Type:Individual
Prefix:MR
First Name:SCOTT
Middle Name:K
Last Name:BEARDSLEY
Suffix:
Gender:M
Credentials:MA, MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1100 S COAST HWY STE 222
Mailing Address - Street 2:
Mailing Address - City:LAGUNA BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92651-2970
Mailing Address - Country:US
Mailing Address - Phone:949-371-3576
Mailing Address - Fax:
Practice Address - Street 1:1100 S COAST HWY STE 222
Practice Address - Street 2:
Practice Address - City:LAGUNA BEACH
Practice Address - State:CA
Practice Address - Zip Code:92651-2970
Practice Address - Country:US
Practice Address - Phone:949-371-3576
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-05
Last Update Date:2010-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA48363106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist