Provider Demographics
NPI:1477574523
Name:BEHAVIORAL SUPPORT SERVICES INC.
Entity Type:Organization
Organization Name:BEHAVIORAL SUPPORT SERVICES INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ANTONIO
Authorized Official - Middle Name:
Authorized Official - Last Name:BUONO
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:661-424-1314
Mailing Address - Street 1:PO BOX 2357
Mailing Address - Street 2:
Mailing Address - City:CANYON COUNTRY
Mailing Address - State:CA
Mailing Address - Zip Code:91386-2357
Mailing Address - Country:US
Mailing Address - Phone:661-424-1314
Mailing Address - Fax:661-424-9447
Practice Address - Street 1:17547 VENTURA BLVD
Practice Address - Street 2:SUITE 307A
Practice Address - City:ENCINO
Practice Address - State:CA
Practice Address - Zip Code:91316-3853
Practice Address - Country:US
Practice Address - Phone:818-995-1333
Practice Address - Fax:661-424-9447
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC20858106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty