Provider Demographics
NPI:1205117959
Name:BEHAVIORAL HEALTH SERVICES
Entity type:Organization
Organization Name:BEHAVIORAL HEALTH SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COUNSELOR II
Authorized Official - Prefix:
Authorized Official - First Name:MARIA
Authorized Official - Middle Name:DE JESUS
Authorized Official - Last Name:ROBLES
Authorized Official - Suffix:
Authorized Official - Credentials:AOD COUNSELOR
Authorized Official - Phone:310-679-9031
Mailing Address - Street 1:15519 CRENSHAW BLVD.
Mailing Address - Street 2:
Mailing Address - City:GARDENA
Mailing Address - State:CA
Mailing Address - Zip Code:90249
Mailing Address - Country:US
Mailing Address - Phone:310-679-9031
Mailing Address - Fax:310-679-9034
Practice Address - Street 1:15519 CRENSHAW BLVD
Practice Address - Street 2:
Practice Address - City:GARDENA
Practice Address - State:CA
Practice Address - Zip Code:90249-4525
Practice Address - Country:US
Practice Address - Phone:310-679-9031
Practice Address - Fax:310-679-9034
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-09-07
Last Update Date:2011-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA104561-CCBCDC3245S0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3245S0500XResidential Treatment FacilitiesSubstance Abuse Rehabilitation FacilitySubstance Abuse Treatment, Children