Healthcare Provider Details

I. General information

NPI: 1265719736
Provider Name (Legal Business Name): BEHAVIORAL INTERVENTION SPECIALISTS OF LA, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/10/2011
Last Update Date: 11/10/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11022 SANTA MONICA BLVD SUITE 120
LOS ANGELES CA
90025-7513
US

IV. Provider business mailing address

11022 SANTA MONICA BLVD SUITE 120
LOS ANGELES CA
90025-7513
US

V. Phone/Fax

Practice location:
  • Phone: 800-258-0659
  • Fax: 310-694-3062
Mailing address:
  • Phone: 800-258-0659
  • Fax: 310-694-3062

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 Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License Number
License Number State

VIII. Authorized Official

Name: EYAL GOLAN
Title or Position: CFO
Credential:
Phone: 800-258-0659