Provider Demographics
NPI:1962971523
Name:BECK, MATTHEW R (LMFT)
Entity type:Individual
Prefix:MR
First Name:MATTHEW
Middle Name:R
Last Name:BECK
Suffix:
Gender:M
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25 BRIDGEPORT ST
Mailing Address - Street 2:
Mailing Address - City:DANA POINT
Mailing Address - State:CA
Mailing Address - Zip Code:92629-3211
Mailing Address - Country:US
Mailing Address - Phone:203-814-2794
Mailing Address - Fax:
Practice Address - Street 1:25 BRIDGEPORT ST
Practice Address - Street 2:
Practice Address - City:DANA POINT
Practice Address - State:CA
Practice Address - Zip Code:92629-3211
Practice Address - Country:US
Practice Address - Phone:203-814-2794
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-11-13
Last Update Date:2018-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALMFT110180106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist