Provider Demographics
NPI:1194989079
Name:BEUTTLER, RICHARD CARL (PSYD)
Entity type:Individual
Prefix:
First Name:RICHARD
Middle Name:CARL
Last Name:BEUTTLER
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19 SKYSAIL DR
Mailing Address - Street 2:
Mailing Address - City:CORONA DEL MAR
Mailing Address - State:CA
Mailing Address - Zip Code:92625-1437
Mailing Address - Country:US
Mailing Address - Phone:949-644-6460
Mailing Address - Fax:
Practice Address - Street 1:19 SKYSAIL DR
Practice Address - Street 2:
Practice Address - City:CORONA DEL MAR
Practice Address - State:CA
Practice Address - Zip Code:92625-1437
Practice Address - Country:US
Practice Address - Phone:949-644-6460
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-07-10
Last Update Date:2008-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY 22032103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical