Healthcare Provider Details

I. General information

NPI: 1902720030
Provider Name (Legal Business Name): GOLDEN STATE BEHAVIORAL HEALTH, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/10/2026
Last Update Date: 08/10/2026
Certification Date: 08/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11230 SORRENTO VALLEY RD STE 225
SAN DIEGO CA
92121-1338
US

IV. Provider business mailing address

11230 SORRENTO VALLEY RD STE 225
SAN DIEGO CA
92121-1338
US

V. Phone/Fax

Practice location:
  • Phone: 916-675-2827
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number
License Number State

VIII. Authorized Official

Name: SEAN MICHAEL PETERSON
Title or Position: CHIEF EXECUTIVE OFFICER
Credential:
Phone: 916-675-2827