Healthcare Provider Details

I. General information

NPI: 1831898881
Provider Name (Legal Business Name): BEHAVIORAL HEALTH SERVICES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/28/2023
Last Update Date: 03/30/2023
Certification Date: 03/30/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12021 SOUTH WILMINGTON AVE. BLDG. #18, SUITE 102
LOS ANGELES CA
90059-3046
US

IV. Provider business mailing address

15519 CRENSHAW BLVD
GARDENA CA
90249-4525
US

V. Phone/Fax

Practice location:
  • Phone: 424-454-6002
  • Fax: 5-583-3969
Mailing address:
  • Phone: 310-679-9126
  • Fax: 310-679-7124

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 Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MICHAEL BALLUE
Title or Position: CHIEF COMPLIANCE OFFICER
Credential: CADC-II, CHC
Phone: 310-679-9126