Provider Demographics
NPI:1912494352
Name:MCBEATH, GARY WAYNE (DR)
Entity Type:Individual
Prefix:MR
First Name:GARY
Middle Name:WAYNE
Last Name:MCBEATH
Suffix:
Gender:M
Credentials:DR
Other - Prefix:
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Mailing Address - Street 1:17821 E 17TH STREET
Mailing Address - Street 2:SUITE # 260
Mailing Address - City:TUSTIN
Mailing Address - State:CA
Mailing Address - Zip Code:92780
Mailing Address - Country:US
Mailing Address - Phone:714-730-7846
Mailing Address - Fax:714-265-4870
Practice Address - Street 1:17821 E 17TH STREET
Practice Address - Street 2:SUITE # 260
Practice Address - City:TUSTIN
Practice Address - State:CA
Practice Address - Zip Code:92780
Practice Address - Country:US
Practice Address - Phone:714-730-7846
Practice Address - Fax:714-265-4870
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-20
Last Update Date:2018-04-20
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
102L00000X
CAMFC40195106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No102L00000XBehavioral Health & Social Service ProvidersPsychoanalyst