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General NPI Number Information
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NPI Number | 1265702997
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Entity Type | Organization
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Legal Business Name | ORION BEHAVIORAL HEALTH NETWORK LLC
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Dates
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Enumeration Date | 01/11/2012
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Last Update Date | 03/11/2025
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Provider Practice Location Address
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Address Line | 16600 CENTERFIELD DR STE 4
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City | EAGLE RIVER
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State | AK
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Zip | 99577-7702
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Country | US
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Telephone | 907-696-7466
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Fax | 907-726-0332
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Provider Business Mailing Address
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Address Line | 200 2ND AVE S # 489
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City | SAINT PETERSBURG
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State | FL
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Zip | 33701-4313
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Country | US
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Telephone | 907-360-1566
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Fax | 907-726-0032
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Authorized Official
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Title or Position | CFO
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Name | JENNIFER ELLEN DESRUISSEAU
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Credential |
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Telephone | 907-360-1566
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2080P0006X
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Taxonomy Name | Developmental - Behavioral Pediatrics Physician
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License Number | 935267
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License Number State | AK
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