Healthcare Provider Details

I. General information

NPI: 1881404671
Provider Name (Legal Business Name): MANIFEST BEHAVIORAL HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/13/2025
Last Update Date: 01/13/2025
Certification Date: 01/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23297 S POINTE DR
LAGUNA HILLS CA
92653-1491
US

IV. Provider business mailing address

23297 S POINTE DR
LAGUNA HILLS CA
92653-1491
US

V. Phone/Fax

Practice location:
  • Phone: 949-280-8360
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. DANIEL AVDEE
Title or Position: COMPLIANCE DIRECTOR
Credential:
Phone: 949-412-4477