Healthcare Provider Details

I. General information

NPI: 1487275673
Provider Name (Legal Business Name): BETTER SOBER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/29/2020
Last Update Date: 10/25/2020
Certification Date: 10/25/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14540 HAMLIN ST STE I
VAN NUYS CA
91411-4154
US

IV. Provider business mailing address

14540 HAMLIN ST STE I
VAN NUYS CA
91411-4154
US

V. Phone/Fax

Practice location:
  • Phone: 323-294-5051
  • Fax:
Mailing address:
  • Phone: 323-294-5051
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number
License Number State

VIII. Authorized Official

Name: LAKECIA HIGGINBOTHAM
Title or Position: CLINICAL DIRECTOR
Credential:
Phone: 323-202-8432