Organization
MIND & BODY HEALTH CLINIC
Active
Other names
Mind & Body Health
Organization subpart
No
Provider details
NPI number
Authorized official
EVAN REID BEECHER (CLINICAL ADMINISTRATOR)
(949) 993-7432
Entity
Organization
Contact information
Practice address
901 DOVER DR STE 214, NEWPORT BEACH, CA 92660-5500
(407) 476-2005
(949) 612-7427
Mailing address
901 DOVER DR STE 214, NEWPORT BEACH, CA 92660-5500
(407) 476-2005
(949) 612-7427
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
—
—
207QA0505X
Adult Medicine Physician
—
—
2084A0401X
Addiction Medicine (Psychiatry & Neurology) Physician
—
—
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
—
—
261QP2300X
Primary Care Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
BT30077324
CA STATE LICENSE NUMBER
—
Enumeration date
12/16/2021
Last updated
03/09/2023
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