Provider Demographics
NPI:1336587427
Name:BEAMAN, GINA (MFT, LEP)
Entity Type:Individual
Prefix:
First Name:GINA
Middle Name:
Last Name:BEAMAN
Suffix:
Gender:F
Credentials:MFT, LEP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:250 W 1ST ST STE 242
Mailing Address - Street 2:
Mailing Address - City:CLAREMONT
Mailing Address - State:CA
Mailing Address - Zip Code:91711-4742
Mailing Address - Country:US
Mailing Address - Phone:909-293-8082
Mailing Address - Fax:
Practice Address - Street 1:250 W 1ST ST STE 242
Practice Address - Street 2:
Practice Address - City:CLAREMONT
Practice Address - State:CA
Practice Address - Zip Code:91711-4742
Practice Address - Country:US
Practice Address - Phone:909-293-8082
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-11
Last Update Date:2023-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC36139106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist