Provider Demographics
NPI:1225302383
Name:ADVANCES IN MENTAL HEALTH &ADDICTIONS TREATMENT CENTER
Entity Type:Organization
Organization Name:ADVANCES IN MENTAL HEALTH &ADDICTIONS TREATMENT CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:BENJAMIN
Authorized Official - Middle Name:A
Authorized Official - Last Name:STEPANOFF
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:562-365-2020
Mailing Address - Street 1:5199 E PACIFIC COAST HWY STE 208
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90804-3388
Mailing Address - Country:US
Mailing Address - Phone:562-365-2020
Mailing Address - Fax:562-498-3331
Practice Address - Street 1:5199 E PACIFIC COAST HWY STE 208
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90804-3388
Practice Address - Country:US
Practice Address - Phone:562-365-2020
Practice Address - Fax:562-498-3331
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-06
Last Update Date:2012-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA101YA0400X, 103TB0200X, 106H00000X
CA190736AP261QR0405X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty
No103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & BehavioralGroup - Multi-Specialty
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty