Individual provider Active NPI

Mackenzie Beckely, LEP, PPSP

  • Psychologist
  • Tustin, CA
National Provider Identifier
1174457410
Registry record updated Jun 11, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
PsychologistTaxonomy code 103T00000X
License
260126195 Issued in CA
Practice address
17772 Irvine Blvd Ste 103
Tustin, CA 92780-3233
Phone
(949) 232-7645
NPI assigned
Jun 11, 2026
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 11, 2026

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Psychologist 103T00000X 260126195 CA Primary

Addresses

Primary practice location

17772 Irvine Blvd Ste 103
Tustin, CA 92780-3233

Mailing address

1939 Wallace Ave Apt 109
Costa Mesa, CA 92627-3492
Phone (949) 232-7645

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1781136000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1781136000000",
    "number": "1174457410",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1939 WALLACE AVE APT 109",
            "city": "COSTA MESA",
            "state": "CA",
            "postal_code": "926273492",
            "telephone_number": "949-232-7645"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "17772 IRVINE BLVD STE 103",
            "city": "TUSTIN",
            "state": "CA",
            "postal_code": "927803233",
            "telephone_number": "949-232-7645"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BECKELY",
        "first_name": "MACKENZIE",
        "credential": "LEP, PPSP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2026-06-11",
        "last_updated": "2026-06-11",
        "certification_date": "2026-06-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "CA",
            "license": "260126195",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Tustin, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 11, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.