Marisol Elisa Beaulac, PSYD

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

3828 Issued in OR

Practice address

2920 SE Brookwood Ave Ste a
Hillsboro, OR 97123-8553

Phone

(971) 417-6054

NPI assigned

May 6, 2019

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Raices de Bienestar

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Hillsboro, OR
  • NPI 1902505316
  NPD
• Pacific University

  • Adult Mental Health Clinic/Center
  • Hillsboro, OR
  • NPI 1700256989
  NPD (past)

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

{
    "created_epoch": "1557100800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1727740800000",
    "number": "1609431659",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2920 SE BROOKWOOD AVE STE A",
            "city": "HILLSBORO",
            "state": "OR",
            "postal_code": "971238553",
            "telephone_number": "503-352-7333"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2920 SE BROOKWOOD AVE STE A",
            "city": "HILLSBORO",
            "state": "OR",
            "postal_code": "971238553",
            "telephone_number": "971-417-6054"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BEAULAC",
        "first_name": "MARISOL",
        "middle_name": "ELISA",
        "name_prefix": "Dr.",
        "credential": "PSYD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-05-06",
        "last_updated": "2024-10-01",
        "certification_date": "2024-10-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "OR",
            "license": "3828",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1700256989",
            "state": "OR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Alexandra Jennifer Beard
• Mitchell Sterling Beard
• Christopher Beasley
• Devin Rylee Beattie
• Sydney Beatty, MD
• Brenda Lilian Becerra, CMA
• Abigail Beck
• Quinn Becker
• Stefanie M Beckley, DMD
• Shelby Lynn Beckwith

• Clinical Psychologist in Hillsboro, OR
• Providers in Hillsboro, OR by specialty
• Clinical Psychologist in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 1, 2024; 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.