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General NPI Number Information
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NPI Number | 1831898881
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Entity Type | Organization
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Legal Business Name | BEHAVIORAL HEALTH SERVICES, INC.
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Dates
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Enumeration Date | 02/28/2023
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Last Update Date | 03/30/2023
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Provider Practice Location Address
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Address Line | 12021 SOUTH WILMINGTON AVE. BLDG. #18, SUITE 102
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City | LOS ANGELES
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State | CA
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Zip | 90059-3046
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Country | US
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Telephone | 424-454-6002
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Fax | 5-583-3969
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Provider Business Mailing Address
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Address Line | 15519 CRENSHAW BLVD
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City | GARDENA
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State | CA
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Zip | 90249-4525
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Country | US
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Telephone | 310-679-9126
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Fax | 310-679-7124
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Authorized Official
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Title or Position | CHIEF COMPLIANCE OFFICER
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Name | MICHAEL BALLUE
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Credential | CADC-II, CHC
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Telephone | 310-679-9126
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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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Taxonomy #2
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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