Healthcare Provider Details

I. General information

NPI: 1013528108
Provider Name (Legal Business Name): BEHAVIORAL HEALTH SERVICES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/12/2020
Last Update Date: 08/12/2020
Certification Date: 08/12/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12954 HAWTHORNE BLVD STE 100
HAWTHORNE CA
90250-4418
US

IV. Provider business mailing address

15519 CRENSHAW BLVD
GARDENA CA
90249-4525
US

V. Phone/Fax

Practice location:
  • Phone: 310-978-6900
  • Fax: 310-218-5484
Mailing address:
  • Phone: 310-679-9126
  • Fax: 310-679-2920

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QF0400X
TaxonomyFederally Qualified Health Center (FQHC)
License Number
License Number State

VIII. Authorized Official

Name: MS. SHIRLEY SUMMERS
Title or Position: PRESIDENT/CEO
Credential: LCSW
Phone: 310-679-9126