Healthcare Provider Details

I. General information

NPI: 1184752560
Provider Name (Legal Business Name): BEHAVIORAL HEALTH SERVICES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/28/2007
Last Update Date: 06/07/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6838 W SUNSET BLVD
HOLLYWOOD CA
90028-7008
US

IV. Provider business mailing address

15519 CRENSHAW BLVD
GARDENA CA
90249-4525
US

V. Phone/Fax

Practice location:
  • Phone: 323-461-3161
  • Fax: 323-461-5683
Mailing address:
  • Phone: 310-679-9126
  • Fax: 310-679-2920

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number19007AN
License Number StateCA

VIII. Authorized Official

Name: MS. THERESA LYNN CANNON
Title or Position: CHIEF COMPLIANCE OFFICER
Credential:
Phone: 310-679-9126