Healthcare Provider Details

I. General information

NPI: 1013018266
Provider Name (Legal Business Name): COMPREHENSIVE BEHAVIORAL HEALTH CARE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/26/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1396 N WATERMAN AVE SUITE #110
SAN BERNARDINO CA
92404-5313
US

IV. Provider business mailing address

1396 N WATERMAN AVE SUITE #110
SAN BERNARDINO CA
92404-5313
US

V. Phone/Fax

Practice location:
  • Phone: 800-678-3127
  • Fax: 800-929-8557
Mailing address:
  • Phone: 800-678-3127
  • Fax: 800-929-8557

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084F0202X
TaxonomyForensic Psychiatry Physician
License NumberA84067
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code2084P0015X
TaxonomyPsychosomatic Medicine Physician
License NumberA84067
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberA84067
License Number StateCA
# 4
Primary TaxonomyN
Taxonomy Code2084P0802X
TaxonomyAddiction Psychiatry Physician
License NumberA84067
License Number StateCA
# 5
Primary TaxonomyN
Taxonomy Code2084P2900X
TaxonomyPain Medicine (Psychiatry & Neurology) Physician
License NumberA84067
License Number StateCA
# 6
Primary TaxonomyN
Taxonomy Code2084P0805X
TaxonomyGeriatric Psychiatry Physician
License NumberA84067
License Number StateCA
# 7
Primary TaxonomyN
Taxonomy Code2084S0012X
TaxonomySleep Medicine (Psychiatry & Neurology) Physician
License NumberA84067
License Number StateCA
# 8
Primary TaxonomyN
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License NumberA84067
License Number StateCA
# 9
Primary TaxonomyN
Taxonomy Code207QG0300X
TaxonomyGeriatric Medicine (Family Medicine) Physician
License NumberA84067
License Number StateCA
# 10
Primary TaxonomyY
Taxonomy Code207QA0401X
TaxonomyAddiction Medicine (Family Medicine) Physician
License NumberA84067
License Number StateCA

VIII. Authorized Official

Name: DR. LAWRENCE VERNON TUCKER
Title or Position: CEO
Credential: M.D.
Phone: 800-678-3127