Provider Demographics
NPI:1306941596
Name:ADVANCED BEHAVIORAL CARE, INC. A PSYCHOLOGICAL CORPORATION
Entity type:Organization
Organization Name:ADVANCED BEHAVIORAL CARE, INC. A PSYCHOLOGICAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:STUART
Authorized Official - Middle Name:
Authorized Official - Last Name:KIRSCHBAUM
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:949-215-2500
Mailing Address - Street 1:27001 LA PAZ RD
Mailing Address - Street 2:SUITE 418
Mailing Address - City:MISSION VIEJO
Mailing Address - State:CA
Mailing Address - Zip Code:92691-5502
Mailing Address - Country:US
Mailing Address - Phone:949-215-2500
Mailing Address - Fax:949-203-8686
Practice Address - Street 1:27001 LA PAZ RD
Practice Address - Street 2:SUITE 418
Practice Address - City:MISSION VIEJO
Practice Address - State:CA
Practice Address - Zip Code:92691-5502
Practice Address - Country:US
Practice Address - Phone:949-215-2500
Practice Address - Fax:949-203-8686
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-13
Last Update Date:2011-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY12070103T00000X
CAPSY12071103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW17078Medicare ID - Type Unspecified