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General NPI Number Information
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NPI Number | 1487703385
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Entity Type | Organization
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Legal Business Name | BEHAVIORAL HEALTH ASSOCIATES MEDICAL GROUP, INC.
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Dates
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Enumeration Date | 01/09/2007
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Last Update Date | 11/12/2015
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Provider Practice Location Address
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Address Line | 4542 RUFFNER ST SUITE 200
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City | SAN DIEGO
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State | CA
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Zip | 92111-2237
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Country | US
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Telephone | 619-528-4600
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Fax | 619-528-4625
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Provider Business Mailing Address
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Address Line | 4542 RUFFNER ST SUITE 200
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City | SAN DIEGO
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State | CA
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Zip | 92111-2237
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Country | US
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Telephone | 619-528-4600
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Fax | 619-528-4625
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Authorized Official
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Title or Position | CREDENTIALING MANAGER
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Name | HEATHER GUDE
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Credential | M.A.
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Telephone | 619-528-4600
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number |
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License Number State |
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