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General NPI Number Information
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NPI Number | 1700362118
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Entity Type | Organization
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Legal Business Name | MINDFUL BEHAVIORAL OUTPATIENT DISCOVERING YOUR SELF
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Dates
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Enumeration Date | 07/18/2018
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Last Update Date | 05/06/2025
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Provider Practice Location Address
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Address Line | 717 PIER VIEW WAY
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City | OCEANSIDE
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State | CA
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Zip | 92054-2801
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Country | US
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Telephone | 951-870-6734
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Fax |
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Provider Business Mailing Address
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Address Line | 717 PIER VIEW WAY
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City | OCEANSIDE
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State | CA
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Zip | 92054-2801
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Country | US
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Telephone | 760-994-8846
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Fax | 760-692-2782
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Authorized Official
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Title or Position | PRESIDENT
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Name | LILLIAN ALEXANDER
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Credential |
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Telephone | 760-209-6557
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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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 | 261QM0855X
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Taxonomy Name | Adolescent and Children Mental Health Clinic/Center
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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 | 261QR0405X
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Taxonomy Name | Substance Use Disorder Rehabilitation Clinic/Center
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License Number |
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License Number State |
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