Healthcare Provider Details

I. General information

NPI: 1316851074
Provider Name (Legal Business Name): NEXA BEHAVIORAL HEALTH INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/30/2026
Last Update Date: 09/30/2026
Certification Date: 09/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1445 E LOS ANGELES AVE STE 104
SIMI VALLEY CA
93065-2826
US

IV. Provider business mailing address

1445 E LOS ANGELES AVE STE 104
SIMI VALLEY CA
93065-2826
US

V. Phone/Fax

Practice location:
  • Phone: 805-823-5966
  • Fax:
Mailing address:
  • Phone: 805-823-5966
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number StateNULL

VIII. Authorized Official

Name: MR. JOHN J POLENO
Title or Position: CEO
Credential: CADC II
Phone: 805-823-5966