Basic Information
| Provider Information | |||||||||
| NPI: | 1285944546 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | ASCENT BEHAVIORAL HEALTH SERVICES | ||||||||
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| Mailing Information | |||||||||
| Address1: | 366 SW 5TH AVE | ||||||||
| Address2: | SUITE 100 | ||||||||
| City: | MERIDIAN | ||||||||
| State: | ID | ||||||||
| PostalCode: | 836428600 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2083239130 | ||||||||
| FaxNumber: | 2083239070 | ||||||||
| Practice Location | |||||||||
| Address1: | 366 SW 5TH AVE | ||||||||
| Address2: | SUITE 100 | ||||||||
| City: | MERIDIAN | ||||||||
| State: | ID | ||||||||
| PostalCode: | 836428600 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2083239130 | ||||||||
| FaxNumber: | 2083239070 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/20/2010 | ||||||||
| LastUpdateDate: | 10/20/2010 | ||||||||
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| AuthorizedOfficialLastName: | EVANS | ||||||||
| AuthorizedOfficialFirstName: | JEREMY | ||||||||
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| AuthorizedOfficialTitleorPosition: | BILLING SUPERVISOR | ||||||||
| AuthorizedOfficialTelephone: | 2083239130 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103TP2701X | Y | 193400000X SINGLE SPECIALTY GROUP | Behavioral Health & Social Service Providers | Psychologist | Group Psychotherapy |
No ID Information.