Healthcare Provider Details

I. General information

NPI: 1366262883
Provider Name (Legal Business Name): PURE MENTAL HEALTH INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/10/2024
Last Update Date: 10/10/2024
Certification Date: 10/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10650 REAGAN ST UNIT 824
LOS ALAMITOS CA
90720-8844
US

IV. Provider business mailing address

10650 REAGAN ST UNIT 824
LOS ALAMITOS CA
90720-8844
US

V. Phone/Fax

Practice location:
  • Phone: 310-447-3842
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number
License Number State

VIII. Authorized Official

Name: GINGER HULST
Title or Position: PRESIDENT, DIRECTOR
Credential: DNP, NP-C
Phone: 310-447-3842