Healthcare Provider Details

I. General information

NPI: 1548659105
Provider Name (Legal Business Name): BEHAVIORAL HEALTH SERVICES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/20/2015
Last Update Date: 07/26/2024
Certification Date: 07/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2501 W EL SEGUNDO BLVD SUITE B
HAWTHORNE CA
90250-3317
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 Code261QC1500X
TaxonomyCommunity Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MICHAEL BALLUE
Title or Position: CHIEF COMPLIANCE OFFICER
Credential:
Phone: 310-679-9126