Healthcare Provider Details

I. General information

NPI: 1245026962
Provider Name (Legal Business Name): SOUTH COAST BEHAVIORAL HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/18/2025
Last Update Date: 04/18/2025
Certification Date: 04/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12532 VENTURA BLVD
STUDIO CITY CA
91604-2412
US

IV. Provider business mailing address

1590 S CONGRESS AVE
PALM SPRINGS FL
33406-5957
US

V. Phone/Fax

Practice location:
  • Phone: 949-531-1821
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: KYLEE BRINEY
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 949-531-1821