Provider Demographics
NPI:1215260138
Name:BEAUCHAMP, EVALYN (LCSW)
Entity type:Individual
Prefix:
First Name:EVALYN
Middle Name:
Last Name:BEAUCHAMP
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1834 BELLA OAKS WAY
Mailing Address - Street 2:
Mailing Address - City:HANFORD
Mailing Address - State:CA
Mailing Address - Zip Code:93230-8948
Mailing Address - Country:US
Mailing Address - Phone:323-228-5962
Mailing Address - Fax:
Practice Address - Street 1:2311 W EL SEGUNDO BLVD
Practice Address - Street 2:
Practice Address - City:HAWTHORNE
Practice Address - State:CA
Practice Address - Zip Code:90250-3315
Practice Address - Country:US
Practice Address - Phone:323-241-6730
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-09
Last Update Date:2023-02-03
Deactivation Date:2014-08-18
Deactivation Code:
Reactivation Date:2023-02-01
Provider Licenses
StateLicense IDTaxonomies
390200000X
CA1089031041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program