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General NPI Number Information
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NPI Number | 1588109953
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Entity Type | Organization
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Legal Business Name | ACHIEVE BEHAVIORAL HEALTH
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Dates
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Enumeration Date | 12/21/2016
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Last Update Date | 04/22/2017
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Provider Practice Location Address
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Address Line | 1420 VANCE ST
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City | LAKEWOOD
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State | CO
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Zip | 80214-4285
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Country | US
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Telephone | 845-321-2049
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Fax |
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Provider Business Mailing Address
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Address Line | 2001 S GARNETT RD SUITE G
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City | TULSA
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State | OK
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Zip | 74128-1836
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Country | US
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Telephone | 845-321-2049
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | JUDSON COOK
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Credential |
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Telephone | 845-321-2049
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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