Basic Information
| Provider Information | |||||||||
| NPI: | 1083125272 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BINFORD | ||||||||
| FirstName: | LOU | ||||||||
| MiddleName: | PAUL | ||||||||
| NamePrefix: | MR. | ||||||||
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| Credential: | CADC-11 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1202 MORENA BLVD STE 203 | ||||||||
| Address2: | |||||||||
| City: | SAN DIEGO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 921103843 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6193983261 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 3288 EL CAJON BLVD STE 13 | ||||||||
| Address2: | |||||||||
| City: | SAN DIEGO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 921041430 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6195215720 | ||||||||
| FaxNumber: | 6195215728 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/16/2017 | ||||||||
| LastUpdateDate: | 04/02/2019 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YA0400X | Y | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) |
ID Information
| ID | Type | State | Issuer | Description | 3704 | 05 | CA | MEDICAID |