| Source 1 Behavioral Services, Llc | |
|
222 W 6th St Ste 400 San Pedro CA 90731-3345 | |
| (562) 708-7639 | |
| Not Available |
| Full Name | Source 1 Behavioral Services, Llc |
|---|---|
| Speciality | Community/behavioral Health |
| Location | 222 W 6th St Ste 400, San Pedro, California |
| Authorized Official Name and Position | Danielle Marie Baker (EXECUTIVE DIRECTOR/OWNER) |
| Authorized Official Contact | 5627087639 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Source 1 Behavioral Services, Llc 222 W 6th St Ste 400 San Pedro CA 90731-3345 Ph: (562) 708-7639 | Source 1 Behavioral Services, Llc 222 W 6th St Ste 400 San Pedro CA 90731-3345 Ph: (562) 708-7639 |
| NPI Number | 1356016539 |
|---|---|
| Provider Enumeration Date | 08/10/2021 |
| Last Update Date | 08/10/2021 |
| Certification Date | 08/10/2021 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1356016539 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | (* (Not Available)) | Secondary |
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