MEDICARE: BEHAVIORAL HEALTH SERVICES INC.

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QC1500X	Community Health Clinic/Center	550003493	CA

General Provider Information

NPI Number	:	1578079919
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BEHAVIORAL HEALTH SERVICES INC.

Provider Business Mailing Address
First Line	:	15519 CRENSHAW BLVD
Second Line	:
City	:	GARDENA
State	:	CA
Zip	:	90249-4525
Country	:	US
Telephone Number	:	310-679-9126
Fax Number	:	310-679-2920

Provider Business Practice Location Address
First Line	:	2015 W 1ST ST STE L
Second Line	:
City	:	SANTA ANA
State	:	CA
Zip	:	92703-3516
Country	:	US
Telephone Number	:	949-245-1001
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT/CEO
Name	:	MS. SHIRLEY ANN SUMMERS
Credential	:	LCSW
Telephone Number	:	310-679-9126

Provider Enumeration Date	:	12/21/2017
Last Update Date	:	12/21/2017

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