Healthcare Provider Details

I. General information

NPI: 1174607626
Provider Name (Legal Business Name): WINDSTONE BEHAVIORAL HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/24/2006
Last Update Date: 04/18/2023
Certification Date: 05/03/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12377 LEWIS ST STE 105
GARDEN GROVE CA
92840-4691
US

IV. Provider business mailing address

151 KALMUS DR STE K2
COSTA MESA CA
92626-5975
US

V. Phone/Fax

Practice location:
  • Phone: 866-388-2810
  • Fax: 714-495-3298
Mailing address:
  • Phone: 866-388-2810
  • Fax: 714-384-3879

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code2084P0805X
TaxonomyGeriatric Psychiatry Physician
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State
# 7
Primary TaxonomyN
Taxonomy Code364SP0808X
TaxonomyPsychiatric/Mental Health Clinical Nurse Specialist
License Number
License Number State
# 8
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State

VIII. Authorized Official

Name: PETER JAMES DAVIDSON
Title or Position: CEO
Credential:
Phone: 714-335-8406