Provider Demographics
NPI:1699126953
Name:BEAVER, DEBORAH J (MS, LMFT, CATC IV)
Entity type:Individual
Prefix:
First Name:DEBORAH
Middle Name:J
Last Name:BEAVER
Suffix:
Gender:F
Credentials:MS, LMFT, CATC IV
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30011 IVY GLENN DR STE 216
Mailing Address - Street 2:
Mailing Address - City:LAGUNA NIGUEL
Mailing Address - State:CA
Mailing Address - Zip Code:92677-5018
Mailing Address - Country:US
Mailing Address - Phone:949-683-6949
Mailing Address - Fax:
Practice Address - Street 1:30011 IVY GLENN DR STE 216
Practice Address - Street 2:
Practice Address - City:LAGUNA NIGUEL
Practice Address - State:CA
Practice Address - Zip Code:92677-5018
Practice Address - Country:US
Practice Address - Phone:949-683-6949
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-28
Last Update Date:2016-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALMFT50484106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist