Healthcare Provider Details

I. General information

NPI: 1366230542
Provider Name (Legal Business Name): PACIFIC BEHAVIORAL SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/28/2025
Last Update Date: 04/28/2025
Certification Date: 04/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6120 SUTTER ST
VENTURA CA
93003-2431
US

IV. Provider business mailing address

6120 SUTTER ST
VENTURA CA
93003-2431
US

V. Phone/Fax

Practice location:
  • Phone: 949-751-7233
  • Fax:
Mailing address:
  • Phone: 949-751-7233
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: BENJAMIN ALAN INGALLS
Title or Position: OWNER/BCBA
Credential: BCBA
Phone: 949-751-7233