Basic Information
| Provider Information | |||||||||
| NPI: | 1033123385 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BEAUCHAMP | ||||||||
| FirstName: | LAUREN | ||||||||
| MiddleName: | ELIZABETH | ||||||||
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| Credential: | PH.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2452 FENTON ST | ||||||||
| Address2: | SUITE 202 | ||||||||
| City: | CHULA VISTA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 919143599 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8582791223 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 3325 GREYSTONE DR | ||||||||
| Address2: | |||||||||
| City: | JAMUL | ||||||||
| State: | CA | ||||||||
| PostalCode: | 919351541 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6195882680 | ||||||||
| FaxNumber: | 8584676933 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/29/2006 | ||||||||
| LastUpdateDate: | 10/08/2010 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103TC0700X | PSY19559 | CA | Y | Behavioral Health & Social Service Providers | Psychologist | Clinical |
No ID Information.