Healthcare Provider Details

I. General information

NPI: 1578079919
Provider Name (Legal Business Name): BEHAVIORAL HEALTH SERVICES INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/21/2017
Last Update Date: 12/21/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2015 W 1ST ST STE L
SANTA ANA CA
92703-3516
US

IV. Provider business mailing address

15519 CRENSHAW BLVD
GARDENA CA
90249-4525
US

V. Phone/Fax

Practice location:
  • Phone: 949-245-1001
  • Fax:
Mailing address:
  • Phone: 310-679-9126
  • Fax: 310-679-2920

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QC1500X
TaxonomyCommunity Health Clinic/Center
License Number550003493
License Number StateCA

VIII. Authorized Official

Name: MS. SHIRLEY ANN SUMMERS
Title or Position: PRESIDENT/CEO
Credential: LCSW
Phone: 310-679-9126