Provider Demographics
NPI:1902104540
Name:BEAS, MIRIAN T (MFT ASSOCIATE)
Entity Type:Individual
Prefix:MISS
First Name:MIRIAN
Middle Name:T
Last Name:BEAS
Suffix:
Gender:F
Credentials:MFT ASSOCIATE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:401 ROOSEVELT ST
Mailing Address - Street 2:
Mailing Address - City:CORONA
Mailing Address - State:CA
Mailing Address - Zip Code:92879-1168
Mailing Address - Country:US
Mailing Address - Phone:951-254-6047
Mailing Address - Fax:
Practice Address - Street 1:12968 FREDERICK ST STE A
Practice Address - Street 2:
Practice Address - City:MORENO VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92553-5229
Practice Address - Country:US
Practice Address - Phone:951-208-0150
Practice Address - Fax:951-204-0409
Is Sole Proprietor?:No
Enumeration Date:2011-03-07
Last Update Date:2020-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA117270106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist