Healthcare Provider Details

I. General information

NPI: 1073641478
Provider Name (Legal Business Name): BEHAVIORAL HEALTH SERVICES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/28/2007
Last Update Date: 02/27/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4099 N MISSION RD
LOS ANGELES CA
90032-2554
US

IV. Provider business mailing address

15519 CRENSHAW BLVD
GARDENA CA
90249-4525
US

V. Phone/Fax

Practice location:
  • Phone: 323-221-1746
  • Fax: 323-221-5176
Mailing address:
  • Phone: 310-679-9126
  • Fax: 310-679-2920

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number190007KN
License Number StateCA

VIII. Authorized Official

Name: MR. HENRY VAN OUDHEUSDEN
Title or Position: PRESIDENT/CEO
Credential: M.A., M.S.W.
Phone: 310-679-9126