Healthcare Provider Details

I. General information

NPI: 1043718562
Provider Name (Legal Business Name): ASCEND BEYOND THERAPY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/30/2018
Last Update Date: 01/30/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11622 EL CAMINO REAL
SAN DIEGO CA
92130-2049
US

IV. Provider business mailing address

PO BOX 710253
SANTEE CA
92072-0253
US

V. Phone/Fax

Practice location:
  • Phone: 858-609-9295
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number82991
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number82991
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number82991
License Number StateCA

VIII. Authorized Official

Name: MS. WENDY HARTRICK
Title or Position: OWNER
Credential: LMFT
Phone: 858-609-9295