Provider Demographics
NPI:1760591556
Name:BEERS, THOMAS MOULDING (PHD)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:MOULDING
Last Name:BEERS
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5444 DALEN AVE
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92122-4115
Mailing Address - Country:US
Mailing Address - Phone:858-455-5649
Mailing Address - Fax:
Practice Address - Street 1:5444 DALEN AVE
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92122-4115
Practice Address - Country:US
Practice Address - Phone:858-455-5649
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY 6600103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical