Healthcare Provider Details

I. General information

NPI: 1750081253
Provider Name (Legal Business Name): FORTE BEHAVIORAL HEALTH LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/06/2023
Last Update Date: 03/06/2023
Certification Date: 03/04/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2139 GLENDON AVE
LOS ANGELES CA
90025-6325
US

IV. Provider business mailing address

2139 GLENDON AVE
LOS ANGELES CA
90025-6325
US

V. Phone/Fax

Practice location:
  • Phone: 800-324-1557
  • Fax: 888-260-1621
Mailing address:
  • Phone: 800-324-1557
  • Fax: 888-260-1621

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code106E00000X
TaxonomyAssistant Behavior Analyst
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name: SHANE SHAFFER
Title or Position: COO
Credential:
Phone: 310-562-7363