Provider Demographics
NPI:1134386469
Name:PRIORITY BEHAVIORAL MEDICAL GROUP
Entity type:Organization
Organization Name:PRIORITY BEHAVIORAL MEDICAL GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ROBERTA
Authorized Official - Middle Name:
Authorized Official - Last Name:RICHARDS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-845-3510
Mailing Address - Street 1:500 E OLIVE AVE
Mailing Address - Street 2:SUITE 830
Mailing Address - City:BURBANK
Mailing Address - State:CA
Mailing Address - Zip Code:91501-3316
Mailing Address - Country:US
Mailing Address - Phone:818-845-3510
Mailing Address - Fax:818-845-0525
Practice Address - Street 1:500 E OLIVE AVE
Practice Address - Street 2:SUITE 830
Practice Address - City:BURBANK
Practice Address - State:CA
Practice Address - Zip Code:91501-3316
Practice Address - Country:US
Practice Address - Phone:818-845-3510
Practice Address - Fax:818-845-0528
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PRIORITY BEHAVIORAL MEDICAL GROUP
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-05-22
Last Update Date:2008-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty