Healthcare Provider Details

I. General information

NPI: 1144606161
Provider Name (Legal Business Name): BEHAVIORAL HEALTH SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/31/2015
Last Update Date: 07/31/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15519 CRENSHAW BLVD
GARDENA CA
90249-4525
US

IV. Provider business mailing address

15519 CRENSHAW BLVD
GARDENA CA
90249-4525
US

V. Phone/Fax

Practice location:
  • Phone: 310-679-9126
  • Fax: 310-679-2920
Mailing address:
  • Phone: 310-679-9126
  • Fax: 310-679-2920

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: DENISE SHOOK
Title or Position: DIVISIONAL DIRECTOR
Credential: MSW
Phone: 310-679-9126