Healthcare Provider Details

I. General information

NPI: 1083524920
Provider Name (Legal Business Name): SOUTH BAY BEHAVIORAL HEALTH VIRTUAL, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/11/2026
Last Update Date: 09/11/2026
Certification Date: 09/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2901 W COAST HWY STE 214
NEWPORT BEACH CA
92663-4023
US

IV. Provider business mailing address

1525 AVIATION BLVD STE 121
REDONDO BEACH CA
90278-2805
US

V. Phone/Fax

Practice location:
  • Phone: 844-316-2228
  • Fax:
Mailing address:
  • Phone: 844-316-2228
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: BRETT LASHURE
Title or Position: OWNER/CEO
Credential:
Phone: 760-473-8807