Healthcare Provider Details

I. General information

NPI: 1770309643
Provider Name (Legal Business Name): BEACHMONT BEHAVIORAL HEALTH, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/25/2024
Last Update Date: 11/25/2024
Certification Date: 11/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

701 E SANTA CLARA ST # V-16
VENTURA CA
93001-5972
US

IV. Provider business mailing address

701 E SANTA CLARA ST # V-16
VENTURA CA
93001-5972
US

V. Phone/Fax

Practice location:
  • Phone: 805-585-0165
  • Fax:
Mailing address:
  • Phone: 805-585-0165
  • 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 Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License Number
License Number State

VIII. Authorized Official

Name: JEREMY WILSON
Title or Position: CEO/PRESIDENT/SECRETARY
Credential: PHD, BCBA-D
Phone: 805-585-0165