Healthcare Provider Details

I. General information

NPI: 1912766833
Provider Name (Legal Business Name): BEYOND ADDICTION-RECOVERY SOLUTIONS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/14/2024
Last Update Date: 03/14/2024
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

105 FIR ST #324 SAC ANNEX BLDG
LA GRANDE OR
97850-2663
US

IV. Provider business mailing address

60117 HIGHWAY 203
UNION OR
97883-9521
US

V. Phone/Fax

Practice location:
  • Phone: 541-246-3638
  • Fax: 360-844-5184
Mailing address:
  • Phone: 541-246-3638
  • Fax: 360-844-5184

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State

VIII. Authorized Official

Name: AMY YOUNG
Title or Position: OFFICE MANAGER/CREDENTIALING
Credential:
Phone: 360-210-7301