Provider Demographics
NPI:1073366167
Name:BEYOU BEHAVIORAL SERVICES LLC
Entity Type:Organization
Organization Name:BEYOU BEHAVIORAL SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:AHMED
Authorized Official - Middle Name:
Authorized Official - Last Name:HERSI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:619-354-0777
Mailing Address - Street 1:2770 SPARTA RD STE 700
Mailing Address - Street 2:
Mailing Address - City:CHULA VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:91915-2696
Mailing Address - Country:US
Mailing Address - Phone:619-354-0777
Mailing Address - Fax:
Practice Address - Street 1:600 W BROADWAY
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92101-3311
Practice Address - Country:US
Practice Address - Phone:619-354-7777
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-04-08
Last Update Date:2024-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health