Provider Demographics
NPI:1144461690
Name:BROAD HORIZONS COUNSELING COLLECTIVE
Entity type:Organization
Organization Name:BROAD HORIZONS COUNSELING COLLECTIVE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:VERONICA
Authorized Official - Middle Name:SHEFTZ
Authorized Official - Last Name:WINSTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:310-866-2606
Mailing Address - Street 1:PO BOX 1410
Mailing Address - Street 2:
Mailing Address - City:TOPANGA
Mailing Address - State:CA
Mailing Address - Zip Code:90290-1410
Mailing Address - Country:US
Mailing Address - Phone:310-866-2606
Mailing Address - Fax:310-455-1416
Practice Address - Street 1:5923 KANAN RD
Practice Address - Street 2:
Practice Address - City:AGOURA HILLS
Practice Address - State:CA
Practice Address - Zip Code:91301-1688
Practice Address - Country:US
Practice Address - Phone:310-866-2606
Practice Address - Fax:310-455-1416
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-12
Last Update Date:2025-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY14856103T00000X
1041C0700X, 261QM0801X
CAMFC42941106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty