Healthcare Provider Details

I. General information

NPI: 1124529466
Provider Name (Legal Business Name): ADVANCES IN MENTAL HEALTH & ADDICTIONS TREATMENT CTR
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/22/2018
Last Update Date: 03/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5199 E PACIFIC COAST HWY STE 330N
LONG BEACH CA
90804-3353
US

IV. Provider business mailing address

PO BOX 5576
LOS ALAMITOS CA
90721-5576
US

V. Phone/Fax

Practice location:
  • Phone: 562-365-2020
  • Fax:
Mailing address:
  • Phone: 562-365-2020
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: BENJAMIN STEPANOFF
Title or Position: CEO
Credential: PSYD
Phone: 562-810-2221