Provider Demographics
NPI:1427073550
Name:MINOR, BEVERLY (MA)
Entity type:Individual
Prefix:
First Name:BEVERLY
Middle Name:
Last Name:MINOR
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:325 CARLSBAD VILLAGE DR
Mailing Address - Street 2:SUITE F-2
Mailing Address - City:CARLSBAD
Mailing Address - State:CA
Mailing Address - Zip Code:92008-2928
Mailing Address - Country:US
Mailing Address - Phone:760-434-4636
Mailing Address - Fax:760-434-5837
Practice Address - Street 1:325 CARLSBAD VILLAGE DR
Practice Address - Street 2:SUITE F-2
Practice Address - City:CARLSBAD
Practice Address - State:CA
Practice Address - Zip Code:92008-2928
Practice Address - Country:US
Practice Address - Phone:760-434-4636
Practice Address - Fax:760-434-5837
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC31584106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist