=====================================================
General NPI Number Information
=====================================================
NPI Number | 1306941596
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ADVANCED BEHAVIORAL CARE, INC. A PSYCHOLOGICAL CORPORATION
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/13/2006
-----------------------------------------------------
Last Update Date | 01/28/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 27001 LA PAZ RD SUITE 418
-----------------------------------------------------
City | MISSION VIEJO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92691-5502
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 949-215-2500
-----------------------------------------------------
Fax | 949-203-8686
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 27001 LA PAZ RD SUITE 418
-----------------------------------------------------
City | MISSION VIEJO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92691-5502
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 949-215-2500
-----------------------------------------------------
Fax | 949-203-8686
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. STUART KIRSCHBAUM
-----------------------------------------------------
Credential | PH.D.
-----------------------------------------------------
Telephone | 949-215-2500
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 103T00000X
-----------------------------------------------------
Taxonomy Name | Psychologist
-----------------------------------------------------
License Number | PSY12070
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 103T00000X
-----------------------------------------------------
Taxonomy Name | Psychologist
-----------------------------------------------------
License Number | PSY12071
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------