Healthcare Provider Details

I. General information

NPI: 1205784170
Provider Name (Legal Business Name): ODYSSEY BEHAVIORAL HEALTH CENTERS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/17/2026
Last Update Date: 08/25/2026
Certification Date: 08/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17821 17TH ST STE 275
TUSTIN CA
92780-2161
US

IV. Provider business mailing address

16593 CHINA BERRY CT
CHINO HILLS CA
91709-6390
US

V. Phone/Fax

Practice location:
  • Phone: 840-228-7740
  • Fax:
Mailing address:
  • Phone: 840-228-7740
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number
License Number State

VIII. Authorized Official

Name: JACOB DANIEL MCCOLLUM
Title or Position: CEO
Credential:
Phone: 840-228-7740