Provider Demographics
NPI:1790390359
Name:INSTITUTE OF BEHAVIORAL SCIENCES AND TECHNOLOGY FAMILY COUNSELING P.C.
Entity Type:Organization
Organization Name:INSTITUTE OF BEHAVIORAL SCIENCES AND TECHNOLOGY FAMILY COUNSELING P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT / CEO
Authorized Official - Prefix:
Authorized Official - First Name:PHILLIP
Authorized Official - Middle Name:E
Authorized Official - Last Name:SALAS
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:619-387-8272
Mailing Address - Street 1:2160 FLETCHER PKWY STE 105
Mailing Address - Street 2:
Mailing Address - City:EL CAJON
Mailing Address - State:CA
Mailing Address - Zip Code:92020-2117
Mailing Address - Country:US
Mailing Address - Phone:619-387-8272
Mailing Address - Fax:619-314-5161
Practice Address - Street 1:2160 FLETCHER PKWY STE 105
Practice Address - Street 2:
Practice Address - City:EL CAJON
Practice Address - State:CA
Practice Address - Zip Code:92020-2117
Practice Address - Country:US
Practice Address - Phone:619-387-8272
Practice Address - Fax:619-314-5161
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-09-10
Last Update Date:2023-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No251S00000XAgenciesCommunity/Behavioral Health
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1134621485Medicaid