MEDICARE: PURE MENTAL HEALTH INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)
2	261QR0405X	Substance Use Disorder Rehabilitation Clinic/Center
3	324500000X	Substance Abuse Rehabilitation Facility
4	251S00000X	Community/Behavioral Health Agency

General Provider Information

NPI Number	:	1366262883
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PURE MENTAL HEALTH INC.

Provider Business Mailing Address
First Line	:	10650 REAGAN ST UNIT 824
Second Line	:
City	:	LOS ALAMITOS
State	:	CA
Zip	:	90720-8844
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	10650 REAGAN ST UNIT 824
Second Line	:
City	:	LOS ALAMITOS
State	:	CA
Zip	:	90720-8844
Country	:	US
Telephone Number	:	310-447-3842
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT, DIRECTOR
Name	:	GINGER HULST
Credential	:	DNP, NP-C
Telephone Number	:	310-447-3842

Provider Enumeration Date	:	10/10/2024
Last Update Date	:	10/10/2024

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