Provider Demographics
NPI:1609828755
Name:BEHAVIORAL MENTAL HEALTH, P.C.
Entity Type:Organization
Organization Name:BEHAVIORAL MENTAL HEALTH, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARJAN
Authorized Official - Middle Name:
Authorized Official - Last Name:DAVOUDI
Authorized Official - Suffix:
Authorized Official - Credentials:PSY D
Authorized Official - Phone:858-205-5486
Mailing Address - Street 1:PO BOX 2585
Mailing Address - Street 2:
Mailing Address - City:LA JOLLA
Mailing Address - State:CA
Mailing Address - Zip Code:92038-2585
Mailing Address - Country:US
Mailing Address - Phone:858-205-5486
Mailing Address - Fax:
Practice Address - Street 1:3111 CAMINO DEL RIO N STE 400
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92108-5724
Practice Address - Country:US
Practice Address - Phone:858-205-5486
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-17
Last Update Date:2023-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL060009174103T00000X
103TC0700X, 261QH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
No103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty
No261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth ServiceGroup - Single Specialty