Healthcare Provider Details

I. General information

NPI: 1235952649
Provider Name (Legal Business Name): EXPERIENCE MENTAL AND BEHAVIORAL HEALTH, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/04/2024
Last Update Date: 11/04/2024
Certification Date: 11/01/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12130 VICTORY BLVD SUITE A
NORTH HOLLYWOOD CA
91606
US

IV. Provider business mailing address

12130 VICTORY BLVD SUITE A
NORTH HOLLYWOOD CA
91606
US

V. Phone/Fax

Practice location:
  • Phone: 888-264-6168
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084A0401X
TaxonomyAddiction Medicine (Psychiatry & Neurology) Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. ADNAN ELIAS KHOURY
Title or Position: PSYCHIATRIST/PRESIDENT/CEO
Credential: MD
Phone: 818-421-4871