Provider Demographics
NPI:1609126226
Name:BEALE, JESSICA (PSYD)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:
Last Name:BEALE
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1031 W 34TH ST STE 300
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90089-3602
Mailing Address - Country:US
Mailing Address - Phone:213-740-7711
Mailing Address - Fax:
Practice Address - Street 1:1031 W 34TH ST STE 300
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90089-3602
Practice Address - Country:US
Practice Address - Phone:213-740-7711
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-09-11
Last Update Date:2019-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA27400103TC0700X
225C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225C00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Counselor
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical