Healthcare Provider Details

I. General information

NPI: 1750995072
Provider Name (Legal Business Name): ASCENSION BEHAVIORAL SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/03/2020
Last Update Date: 09/03/2020
Certification Date: 09/03/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

350 SE ANDREWS ST
ISSAQUAH WA
98027-3413
US

IV. Provider business mailing address

1567 HIGHLANDS DR NE STE 110
ISSAQUAH WA
98029-6256
US

V. Phone/Fax

Practice location:
  • Phone: 248-412-3964
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code106E00000X
TaxonomyAssistant Behavior Analyst
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name: CHRISTEN ANN RAE
Title or Position: OWNER
Credential: M.A., BCBA, LBA
Phone: 248-412-3964