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

General Provider Information

NPI Number	:	1962963645
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	:	4511 WHITTIER BLVD
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90022-2407
Country	:	US
Telephone Number	:	323-264-2890
Fax Number	:	323-268-2515

Authorized Official
Title or Position	:	CHIEF COMPLIANCE OFFICER
Name	:	DEBBIE LEVAN
Credential	:	MPH, CCEP, CHC
Telephone Number	:	310-679-9126

Provider Enumeration Date	:	03/26/2019
Last Update Date	:	07/12/2023

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