Healthcare Provider Details

I. General information

NPI: 1215696349
Provider Name (Legal Business Name): PSYCHOLOGICAL BEHAVIORAL TEAM INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/16/2021
Last Update Date: 12/16/2021
Certification Date: 12/16/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2625 TOWNSGATE RD STE 330
WESTLAKE VILLAGE CA
91361-5749
US

IV. Provider business mailing address

2625 TOWNSGATE RD STE 330
WESTLAKE VILLAGE CA
91361-5749
US

V. Phone/Fax

Practice location:
  • Phone: 805-626-0325
  • Fax:
Mailing address:
  • Phone: 805-626-0325
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TM1800X
TaxonomyIntellectual & Developmental Disabilities Psychologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: DR. ALFREDO BIMBELA
Title or Position: CEO/PRESIDENT
Credential: PHD, FNP, PMHNP
Phone: 805-626-0325