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General NPI Number Information
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NPI Number | 1770309643
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Entity Type | Organization
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Legal Business Name | BEACHMONT BEHAVIORAL HEALTH, INC
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Dates
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Enumeration Date | 11/25/2024
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Last Update Date | 11/25/2024
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Provider Practice Location Address
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Address Line | 701 E SANTA CLARA ST # V-16
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City | VENTURA
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State | CA
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Zip | 93001-5972
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Country | US
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Telephone | 805-585-0165
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Fax |
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Provider Business Mailing Address
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Address Line | 701 E SANTA CLARA ST # V-16
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City | VENTURA
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State | CA
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Zip | 93001-5972
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Country | US
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Telephone | 805-585-0165
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Fax |
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Authorized Official
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Title or Position | CEO/PRESIDENT/SECRETARY
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Name | JEREMY WILSON
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Credential | PHD, BCBA-D
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Telephone | 805-585-0165
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251C00000X
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Taxonomy Name | Developmentally Disabled Services Day Training Agency
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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 | 252Y00000X
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Taxonomy Name | Early Intervention Provider Agency
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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 | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number |
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License Number State |
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