Provider Demographics
NPI:1295189660
Name:BECKENBACH MCGANN, HEIDI KATHLEEN (LPCC)
Entity type:Individual
Prefix:
First Name:HEIDI
Middle Name:KATHLEEN
Last Name:BECKENBACH MCGANN
Suffix:
Gender:F
Credentials:LPCC
Other - Prefix:
Other - First Name:HEIDI
Other - Middle Name:KATHLEEN
Other - Last Name:BECKENBACH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PCCI
Mailing Address - Street 1:5100 MARLBOROUGH DR
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92116-2020
Mailing Address - Country:US
Mailing Address - Phone:619-567-7399
Mailing Address - Fax:619-567-7399
Practice Address - Street 1:5100 MARLBOROUGH DR
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92116-2020
Practice Address - Country:US
Practice Address - Phone:619-567-7399
Practice Address - Fax:619-567-7399
Is Sole Proprietor?:No
Enumeration Date:2016-04-21
Last Update Date:2016-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALPCC 2767101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health