Provider Demographics
NPI:1598472805
Name:EXIST CENTERS, LLC
Entity Type:Organization
Organization Name:EXIST CENTERS, LLC
Other - Org Name:EXIST BEHAVIORAL HEALTH
Other - Org Type:Other Name
Authorized Official - Title/Position:FOUNDER/CCO
Authorized Official - Prefix:DR
Authorized Official - First Name:COURTNEY
Authorized Official - Middle Name:M
Authorized Official - Last Name:TRACY
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW, PSYD
Authorized Official - Phone:949-342-6011
Mailing Address - Street 1:580 BROADWAY ST STE 301
Mailing Address - Street 2:
Mailing Address - City:LAGUNA BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92651-4328
Mailing Address - Country:US
Mailing Address - Phone:844-707-2323
Mailing Address - Fax:949-325-2918
Practice Address - Street 1:580 BROADWAY ST STE 301
Practice Address - Street 2:
Practice Address - City:LAGUNA BEACH
Practice Address - State:CA
Practice Address - Zip Code:92651-4328
Practice Address - Country:US
Practice Address - Phone:949-891-1308
Practice Address - Fax:949-325-2918
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-11-04
Last Update Date:2024-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility