Provider Demographics
NPI:1124430038
Name:NEUROBEHAVIORAL HEALTH - A PSYCHOLOGICAL CORPORATION
Entity type:Organization
Organization Name:NEUROBEHAVIORAL HEALTH - A PSYCHOLOGICAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:
Authorized Official - Last Name:FORTMAN
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:805-451-1463
Mailing Address - Street 1:5266 HOLLISTER AVE STE 212
Mailing Address - Street 2:
Mailing Address - City:SANTA BARBARA
Mailing Address - State:CA
Mailing Address - Zip Code:93111-4041
Mailing Address - Country:US
Mailing Address - Phone:805-451-1463
Mailing Address - Fax:
Practice Address - Street 1:5266 HOLLISTER AVE STE 212
Practice Address - Street 2:
Practice Address - City:SANTA BARBARA
Practice Address - State:CA
Practice Address - Zip Code:93111-4041
Practice Address - Country:US
Practice Address - Phone:805-451-1463
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-05-27
Last Update Date:2018-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY26321103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103G00000XBehavioral Health & Social Service ProvidersClinical NeuropsychologistGroup - Single Specialty