Provider Demographics
NPI:1336866094
Name:SPEHERE BEHAVIORAL SERVICES
Entity Type:Organization
Organization Name:SPEHERE BEHAVIORAL SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:BIANCA NICOLE
Authorized Official - Middle Name:DIZON
Authorized Official - Last Name:ARGUELLES
Authorized Official - Suffix:
Authorized Official - Credentials:MS, RBT
Authorized Official - Phone:323-401-5015
Mailing Address - Street 1:410 HAUSER BLVD.
Mailing Address - Street 2:APT. ML
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90036
Mailing Address - Country:US
Mailing Address - Phone:310-401-5015
Mailing Address - Fax:
Practice Address - Street 1:410 HAUSER BLVD APT ML
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90036-5488
Practice Address - Country:US
Practice Address - Phone:323-401-5015
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-10-24
Last Update Date:2022-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
No261QD1600XAmbulatory Health Care FacilitiesClinic/CenterDevelopmental Disabilities