Provider Demographics
NPI:1043899081
Name:BEARD, CHARLOTTE LACE (PHD)
Entity type:Individual
Prefix:DR
First Name:CHARLOTTE
Middle Name:LACE
Last Name:BEARD
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:31831 CAMINO CAPISTRANO STE 111
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN CAPISTRANO
Mailing Address - State:CA
Mailing Address - Zip Code:92675-3220
Mailing Address - Country:US
Mailing Address - Phone:669-210-2563
Mailing Address - Fax:949-264-9261
Practice Address - Street 1:31831 CAMINO CAPISTRANO STE 111
Practice Address - Street 2:
Practice Address - City:SAN JUAN CAPISTRANO
Practice Address - State:CA
Practice Address - Zip Code:92675-3220
Practice Address - Country:US
Practice Address - Phone:669-210-2563
Practice Address - Fax:949-264-9261
Is Sole Proprietor?:No
Enumeration Date:2021-04-06
Last Update Date:2024-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA32466103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist