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NPI Code Detail

MEDICARE: BEHAVIORAL HEALTH SERVICES

MEDICARE: BEHAVIORAL HEALTH SERVICES
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
1101YA0400XAddiction (Substance Use Disorder) CounselorRI-P0884221503CA

General Provider Information

NPI Number : 1730423542
Entity Type Code : Organization
Provider Name (Legal Business Name) : BEHAVIORAL HEALTH SERVICES
Provider Business Mailing Address
First Line : 15519 CRENSHAW BLVD
Second Line :
City : GARDENA
State : CA
Zip : 90249-4525
Country : US
Telephone Number : 310-679-9031
Fax Number : 310-679-9034
Provider Business Practice Location Address
First Line : 15519 CRENSHAW BLVD.
Second Line :
City : GARDENA
State : CA
Zip : 90249-4597
Country : US
Telephone Number : 310-679-9031
Fax Number : 310-679-9034
Authorized Official
Title or Position : CORPORATE COMPLIANCE OFFICER
Name : MRS. DEBBIE LEVAN
Credential : MPH CCEP
Telephone Number : 310-679-9126
Provider Enumeration Date : 11/16/2012
Last Update Date : 11/16/2012

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Directions to “BEHAVIORAL HEALTH SERVICES ” Practice Location

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