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General NPI Number Information
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NPI Number | 1306132790
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Entity Type | Organization
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Legal Business Name | ASSOCIATION OF BEHAVIORAL HEALTH SPECIALISTS
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Dates
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Enumeration Date | 06/23/2011
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Last Update Date | 06/23/2011
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Provider Practice Location Address
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Address Line | 6454 VAN NUYS BLVD SUITE 111
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City | VAN NUYS
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State | CA
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Zip | 91401-1445
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Country | US
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Telephone | 818-336-6441
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Fax | 818-336-6441
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Provider Business Mailing Address
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Address Line | 6454 VAN NUYS BLVD SUITE 111
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City | VAN NUYS
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State | CA
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Zip | 91401-1445
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Country | US
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Telephone | 818-336-6441
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Fax | 818-336-6441
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Authorized Official
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Title or Position | OWNER
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Name | DR. JOSE CORENA
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Credential | PSY.D
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Telephone | 818-336-6441
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | PSY 21815
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License Number State | CA
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