Healthcare Provider Details

I. General information

NPI: 1689128605
Provider Name (Legal Business Name): ASCENDANT BEHAVIORAL HEALTH LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/08/2016
Last Update Date: 10/03/2023
Certification Date: 10/03/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5965 S 900 E STE 100
MURRAY UT
84121-1850
US

IV. Provider business mailing address

PO BOX 671298
DALLAS TX
75267-1298
US

V. Phone/Fax

Practice location:
  • Phone: 801-872-5516
  • Fax: 480-888-9679
Mailing address:
  • Phone: 801-872-5516
  • Fax: 480-888-9679

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number2662563501
License Number StateUT

VIII. Authorized Official

Name: RYAN PARDO
Title or Position: CHIEF LEGAL OFFICER
Credential:
Phone: 425-279-8500