Healthcare Provider Details

I. General information

NPI: 1306941596
Provider Name (Legal Business Name): ADVANCED BEHAVIORAL CARE, INC. A PSYCHOLOGICAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/13/2006
Last Update Date: 01/28/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

27001 LA PAZ RD SUITE 418
MISSION VIEJO CA
92691-5502
US

IV. Provider business mailing address

27001 LA PAZ RD SUITE 418
MISSION VIEJO CA
92691-5502
US

V. Phone/Fax

Practice location:
  • Phone: 949-215-2500
  • Fax: 949-203-8686
Mailing address:
  • Phone: 949-215-2500
  • Fax: 949-203-8686

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberPSY12070
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberPSY12071
License Number StateCA

VIII. Authorized Official

Name: DR. STUART KIRSCHBAUM
Title or Position: PRESIDENT
Credential: PH.D.
Phone: 949-215-2500