Healthcare Provider Details

I. General information

NPI: 1609828755
Provider Name (Legal Business Name): BEHAVIORAL MENTAL HEALTH PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/17/2006
Last Update Date: 06/24/2026
Certification Date: 06/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3111 CAMINO DEL RIO N STE 400
SAN DIEGO CA
92108-5724
US

IV. Provider business mailing address

PO BOX 2585
LA JOLLA CA
92038-2585
US

V. Phone/Fax

Practice location:
  • Phone: 858-205-5486
  • Fax:
Mailing address:
  • Phone: 858-205-5486
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number060009174
License Number StateIL
# 3
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number StateNULL

VIII. Authorized Official

Name: DR. MARJAN DAVOUDI
Title or Position: OWNER
Credential: PSY. D.
Phone: 858-205-5486