Provider Demographics
NPI:1366597601
Name:THERAPEUTIC BEHAVIORAL SERVICES
Entity type:Organization
Organization Name:THERAPEUTIC BEHAVIORAL SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DEPUTY DIRECTOR MENTAL HEALTH SRVC
Authorized Official - Prefix:MR
Authorized Official - First Name:ALFREDO
Authorized Official - Middle Name:
Authorized Official - Last Name:AGUIRRE
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:619-563-2711
Mailing Address - Street 1:PO BOX 85524
Mailing Address - Street 2:MS P-503
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92186-5524
Mailing Address - Country:US
Mailing Address - Phone:619-401-4630
Mailing Address - Fax:619-401-4627
Practice Address - Street 1:1000 BROADWAY
Practice Address - Street 2:SUITE 105
Practice Address - City:EL CAJON
Practice Address - State:CA
Practice Address - Zip Code:92021-4899
Practice Address - Country:US
Practice Address - Phone:619-401-4630
Practice Address - Fax:619-401-4627
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-25
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA37EDMedicaid