Provider Demographics
NPI:1588671432
Name:BEAUPRE, PAT M (PHD)
Entity Type:Individual
Prefix:DR
First Name:PAT
Middle Name:M
Last Name:BEAUPRE
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 293
Mailing Address - Street 2:
Mailing Address - City:BRYN MAWR
Mailing Address - State:CA
Mailing Address - Zip Code:92318-0293
Mailing Address - Country:US
Mailing Address - Phone:909-335-6005
Mailing Address - Fax:909-335-8514
Practice Address - Street 1:511 BROOKSIDE AVE
Practice Address - Street 2:
Practice Address - City:REDLANDS
Practice Address - State:CA
Practice Address - Zip Code:92373-4611
Practice Address - Country:US
Practice Address - Phone:909-335-6005
Practice Address - Fax:909-335-8514
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY 14953103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAOPL149530Medicare ID - Type Unspecified