Healthcare Provider Details

I. General information

NPI: 1235433145
Provider Name (Legal Business Name): SPECIALTY BEHAVIORAL HEALTH, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/06/2011
Last Update Date: 01/06/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3262 HOLIDAY CT
LA JOLLA CA
92037-0026
US

IV. Provider business mailing address

3262 HOLIDAY CT
LA JOLLA CA
92037-0026
US

V. Phone/Fax

Practice location:
  • Phone: 858-752-3520
  • Fax: 858-452-6700
Mailing address:
  • Phone: 858-752-3520
  • Fax: 858-452-6700

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSY18893
License Number StateCA

VIII. Authorized Official

Name: JAMES CARTER
Title or Position: PRESIDENT
Credential: PH.D.
Phone: 858-752-3520