Organization
BESPOKE TREATMENT LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
THI HOANG (BUSINESS OFFICE REPRESENTATIVE)
(702) 205-8232
Entity
Organization
Contact information
Practice address
12381 WILSHIRE BLVD STE 205, LOS ANGELES, CA 90025-1063
(833) 867-2329
Mailing address
12381 WILSHIRE BLVD STE 205, LOS ANGELES, CA 90025-1063
(833) 867-2329
(833) 867-3757
Taxonomy
Speciality
Code
Description
License number
State
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
—
—
261QM0850X
Adult Mental Health Clinic/Center
Primary
—
—
261QM0855X
Adolescent and Children Mental Health Clinic/Center
—
—
261QR0405X
Substance Use Disorder Rehabilitation Clinic/Center
—
—
Other
Enumeration date
08/04/2020
Last updated
12/27/2022
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