Provider Demographics
NPI:1922473420
Name:INSTITUTUE FOR BEHAVIORAL HEALTH
Entity Type:Organization
Organization Name:INSTITUTUE FOR BEHAVIORAL HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CASE SUPERVISOR
Authorized Official - Prefix:
Authorized Official - First Name:YUKI
Authorized Official - Middle Name:
Authorized Official - Last Name:JEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:949-295-6144
Mailing Address - Street 1:20827 SONOITA DR
Mailing Address - Street 2:
Mailing Address - City:WALNUT
Mailing Address - State:CA
Mailing Address - Zip Code:91789
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:410 ALABAMA ST
Practice Address - Street 2:
Practice Address - City:REDLANDS
Practice Address - State:CA
Practice Address - Zip Code:92373
Practice Address - Country:US
Practice Address - Phone:909-289-1041
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-12-09
Last Update Date:2015-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1-14-9853103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty