Healthcare Provider Details

I. General information

NPI: 1225302383
Provider Name (Legal Business Name): ADVANCES IN MENTAL HEALTH &ADDICTIONS TREATMENT CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/06/2012
Last Update Date: 03/13/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5199 E PACIFIC COAST HWY STE 208
LONG BEACH CA
90804-3388
US

IV. Provider business mailing address

5199 E PACIFIC COAST HWY STE 208
LONG BEACH CA
90804-3388
US

V. Phone/Fax

Practice location:
  • Phone: 562-365-2020
  • Fax: 562-498-3331
Mailing address:
  • Phone: 562-365-2020
  • Fax: 562-498-3331

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code103TB0200X
TaxonomyCognitive & Behavioral Psychologist
License Number
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number StateCA
# 4
Primary TaxonomyY
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number190736AP
License Number StateCA

VIII. Authorized Official

Name: DR. BENJAMIN A STEPANOFF
Title or Position: CLINICAL DIRECTOR
Credential: PSYD.
Phone: 562-365-2020