Healthcare Provider Details

I. General information

NPI: 1134386469
Provider Name (Legal Business Name): PRIORITY BEHAVIORAL MEDICAL GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/22/2008
Last Update Date: 05/22/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 E OLIVE AVE SUITE 830
BURBANK CA
91501-3316
US

IV. Provider business mailing address

500 E OLIVE AVE SUITE 830
BURBANK CA
91501-3316
US

V. Phone/Fax

Practice location:
  • Phone: 818-845-3510
  • Fax: 818-845-0528
Mailing address:
  • Phone: 818-845-3510
  • Fax: 818-845-0525

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateCA

VIII. Authorized Official

Name: ROBERTA RICHARDS
Title or Position: OFFICE MANAGER
Credential:
Phone: 818-845-3510