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General NPI Number Information
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NPI Number | 1669333845
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Entity Type | Organization
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Legal Business Name | MALIBU BEHAVIORAL HEALTH SERVICES INC
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Dates
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Enumeration Date | 11/18/2025
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Last Update Date | 11/21/2025
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Provider Practice Location Address
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Address Line | 16365 PICK PL
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City | RIVERSIDE
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State | CA
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Zip | 92504-5638
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Country | US
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Telephone | 714-887-3816
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Fax | 209-203-1061
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Provider Business Mailing Address
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Address Line | 16365 PICK PL
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City | RIVERSIDE
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State | CA
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Zip | 92504-5638
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Country | US
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Telephone | 714-887-3816
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Fax | 209-203-1061
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Authorized Official
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Title or Position | CEO
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Name | ANGELIKA PANOVA BOHANNAN
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Credential | LMFT
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Telephone | 714-887-3816
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 163WP0809X
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Taxonomy Name | Adult Psychiatric/Mental Health Registered Nurse
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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 | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number |
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License Number State |
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