Healthcare Provider Details

I. General information

NPI: 1932891199
Provider Name (Legal Business Name): BIXBY MENTAL HEALTH INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/24/2023
Last Update Date: 05/24/2023
Certification Date: 05/24/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 S SAN VICENTE BLVD STE 100
LOS ANGELES CA
90048-4664
US

IV. Provider business mailing address

9663 SANTA MONICA BLVD STE 883
BEVERLY HILLS CA
90210-4303
US

V. Phone/Fax

Practice location:
  • Phone: 310-873-3312
  • Fax:
Mailing address:
  • Phone: 310-873-3312
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number StateNULL

VIII. Authorized Official

Name: DANIEL LING
Title or Position: CFO
Credential: MD
Phone: 310-956-1123