=====================================================
General NPI Number Information
=====================================================
NPI Number | 1043718562
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ASCEND BEYOND THERAPY
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/30/2018
-----------------------------------------------------
Last Update Date | 01/30/2018
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 11622 EL CAMINO REAL
-----------------------------------------------------
City | SAN DIEGO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92130-2049
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 858-609-9295
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 710253
-----------------------------------------------------
City | SANTEE
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92072-0253
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | MS. WENDY HARTRICK
-----------------------------------------------------
Credential | LMFT
-----------------------------------------------------
Telephone | 858-609-9295
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QM0801X
-----------------------------------------------------
Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
-----------------------------------------------------
License Number | 82991
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 261QM0850X
-----------------------------------------------------
Taxonomy Name | Adult Mental Health Clinic/Center
-----------------------------------------------------
License Number | 82991
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 261QM0855X
-----------------------------------------------------
Taxonomy Name | Adolescent and Children Mental Health Clinic/Center
-----------------------------------------------------
License Number | 82991
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------