Provider Demographics
NPI:1578110953
Name:BEVERLY GARDENS FAMILY THERAPY INC
Entity Type:Organization
Organization Name:BEVERLY GARDENS FAMILY THERAPY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:KERRY
Authorized Official - Middle Name:
Authorized Official - Last Name:O'REILLY
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:310-463-5656
Mailing Address - Street 1:1180 WINTHROP LN
Mailing Address - Street 2:
Mailing Address - City:VENTURA
Mailing Address - State:CA
Mailing Address - Zip Code:93001-4048
Mailing Address - Country:US
Mailing Address - Phone:310-463-5656
Mailing Address - Fax:
Practice Address - Street 1:152 S LASKY DR STE 208E
Practice Address - Street 2:
Practice Address - City:BEVERLY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90212-1720
Practice Address - Country:US
Practice Address - Phone:310-463-5656
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-08-21
Last Update Date:2019-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty