Provider Demographics
NPI:1821711409
Name:BEACH CITIES MENTAL HEALTH, A LIC PROF CLINICAL COUNSELING CORP
Entity Type:Organization
Organization Name:BEACH CITIES MENTAL HEALTH, A LIC PROF CLINICAL COUNSELING CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:B
Authorized Official - Last Name:NIEHAUS
Authorized Official - Suffix:
Authorized Official - Credentials:LPCC, PSYD
Authorized Official - Phone:657-233-0374
Mailing Address - Street 1:22750 HAWTHORNE BLVD STE 205
Mailing Address - Street 2:
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90505-3667
Mailing Address - Country:US
Mailing Address - Phone:657-233-0374
Mailing Address - Fax:
Practice Address - Street 1:22750 HAWTHORNE BLVD STE 205
Practice Address - Street 2:
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90505-3667
Practice Address - Country:US
Practice Address - Phone:657-233-0374
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-09-20
Last Update Date:2022-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounselingGroup - Single Specialty