Provider Demographics
NPI:1699049650
Name:BEHAVIORAL HEALTH SERVICES
Entity type:Organization
Organization Name:BEHAVIORAL HEALTH SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROGRAM DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:ELOISA
Authorized Official - Middle Name:DUENAS
Authorized Official - Last Name:CUENCA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:310-679-9126
Mailing Address - Street 1:505 S PACIFIC AVE
Mailing Address - Street 2:
Mailing Address - City:SAN PEDRO
Mailing Address - State:CA
Mailing Address - Zip Code:90731-2656
Mailing Address - Country:US
Mailing Address - Phone:310-831-2358
Mailing Address - Fax:310-831-2830
Practice Address - Street 1:505 S PACIFIC AVE
Practice Address - Street 2:
Practice Address - City:SAN PEDRO
Practice Address - State:CA
Practice Address - Zip Code:90731-2656
Practice Address - Country:US
Practice Address - Phone:310-831-2358
Practice Address - Fax:310-831-2830
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-08
Last Update Date:2012-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95-283-8006251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health