MEDICARE: ASCENT EVALUATIONS ASSESSMENTS AND COUNSELING, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251S00000X	Community/Behavioral Health Agency

General Provider Information

NPI Number	:	1063814317
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ASCENT EVALUATIONS ASSESSMENTS AND COUNSELING, LLC

Provider Business Mailing Address
First Line	:	560 W CANFIELD AVE
Second Line	:	SUITE 400
City	:	COEUR D ALENE
State	:	ID
Zip	:	83815-7950
Country	:	US
Telephone Number	:	208-667-7777
Fax Number	:	208-667-7772

Provider Business Practice Location Address
First Line	:	560 W CANFIELD AVE
Second Line	:	SUITE 400
City	:	COEUR D ALENE
State	:	ID
Zip	:	83815-7950
Country	:	US
Telephone Number	:	208-667-7777
Fax Number	:	208-667-7772

Authorized Official
Title or Position	:	PRINCIPAL/THERAPIST
Name	:	JENNIFER D SCOTT
Credential	:
Telephone Number	:	208-667-7777

Provider Enumeration Date	:	09/18/2014
Last Update Date	:	09/18/2014

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