Provider Demographics
NPI:1124893482
Name:DESTINY BEHAVIORAL HEALTH
Entity type:Organization
Organization Name:DESTINY BEHAVIORAL HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:ISAAC
Authorized Official - Middle Name:
Authorized Official - Last Name:SEGUN-ABUGAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:924-984-4215
Mailing Address - Street 1:2250 CAMINO RAMON
Mailing Address - Street 2:
Mailing Address - City:SAN RAMON
Mailing Address - State:CA
Mailing Address - Zip Code:94583-1353
Mailing Address - Country:US
Mailing Address - Phone:925-217-2600
Mailing Address - Fax:
Practice Address - Street 1:2250 CAMINO RAMON
Practice Address - Street 2:
Practice Address - City:SAN RAMON
Practice Address - State:CA
Practice Address - Zip Code:94583-1353
Practice Address - Country:US
Practice Address - Phone:925-217-2600
Practice Address - Fax:925-275-1600
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-11-16
Last Update Date:2024-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty