Healthcare Provider Details

I. General information

NPI: 1942529037
Provider Name (Legal Business Name): ADVANCES IN MENTAL HEALTH AND ADDICTIONS TREATMENT INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/27/2010
Last Update Date: 10/17/2024
Certification Date: 10/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5199 E PACIFIC COAST HWY 330N
LONG BEACH CA
90804-3309
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: 562-239-3135

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License NumberPSY22896
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code103TB0200X
TaxonomyCognitive & Behavioral Psychologist
License NumberPSY22896
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSY22896
License Number StateCA

VIII. Authorized Official

Name: MRS. YVETTE STEPANOFF
Title or Position: CLINICAL DIRECTOR
Credential:
Phone: 562-365-2020