Healthcare Provider Details

I. General information

NPI: 1043610892
Provider Name (Legal Business Name): ORION BEHAVIORAL HEALTH NETWORK LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/29/2014
Last Update Date: 03/12/2025
Certification Date: 03/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16600 CENTERFIELD DR STE 4
EAGLE RIVER AK
99577-7702
US

IV. Provider business mailing address

200 2ND AVE S # 489
SAINT PETERSBURG FL
33701-4313
US

V. Phone/Fax

Practice location:
  • Phone: 907-696-7466
  • Fax: 907-726-0332
Mailing address:
  • Phone: 907-360-1566
  • Fax: 907-726-0332

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number935267
License Number StateAK

VIII. Authorized Official

Name: JENNIFER ELLEN DESRUISSEAU
Title or Position: CFO
Credential:
Phone: 907-360-1566