Healthcare Provider Details

I. General information

NPI: 1821711409
Provider Name (Legal Business Name): BEACH CITIES MENTAL HEALTH, A LIC PROF CLINICAL COUNSELING CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/20/2022
Last Update Date: 09/20/2022
Certification Date: 09/20/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22750 HAWTHORNE BLVD STE 205
TORRANCE CA
90505-3667
US

IV. Provider business mailing address

22750 HAWTHORNE BLVD STE 205
TORRANCE CA
90505-3667
US

V. Phone/Fax

Practice location:
  • Phone: 657-233-0374
  • Fax:
Mailing address:
  • Phone: 657-233-0374
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number
License Number State

VIII. Authorized Official

Name: DR. KEVIN B NIEHAUS
Title or Position: EXECUTIVE DIRECTOR
Credential: LPCC, PSYD
Phone: 657-233-0374