Provider Demographics
NPI:1316962269
Name:NEW HORIZONS BEHAVIORAL HEALTH
Entity type:Organization
Organization Name:NEW HORIZONS BEHAVIORAL HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE PROPRIETOR
Authorized Official - Prefix:DR
Authorized Official - First Name:SAMUEL
Authorized Official - Middle Name:PENNY
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:310-370-9715
Mailing Address - Street 1:3835-R E THOUSAND OAKS BLVD STE 325
Mailing Address - Street 2:
Mailing Address - City:WESTLAKE VILLAGE
Mailing Address - State:CA
Mailing Address - Zip Code:91362-6622
Mailing Address - Country:US
Mailing Address - Phone:310-370-9615
Mailing Address - Fax:
Practice Address - Street 1:1127 WILSHIRE BLVD STE 1415
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90017-4005
Practice Address - Country:US
Practice Address - Phone:310-370-9615
Practice Address - Fax:310-370-9617
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA41530A103TC0700X, 305S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
Not Answered305S00000XManaged Care OrganizationsPoint of Service
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW18406Medicare ID - Type Unspecified