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General NPI Number Information
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NPI Number | 1750945135
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Entity Type | Organization
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Legal Business Name | BASURTO BEHAVIORAL HEALTH, LLC
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Dates
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Enumeration Date | 05/01/2019
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Last Update Date | 05/01/2019
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Provider Practice Location Address
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Address Line | 3316 CEDAR HEIGHTS DR STE A
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City | CEDAR FALLS
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State | IA
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Zip | 50613-6083
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Country | US
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Telephone | 319-504-4593
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Fax | 319-260-1212
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Provider Business Mailing Address
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Address Line | 3316 CEDAR HEIGHTS DR STE A
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City | CEDAR FALLS
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State | IA
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Zip | 50613-6083
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Country | US
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Telephone | 319-504-4593
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Fax | 319-260-1212
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Authorized Official
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Title or Position | OWNER/CLINICIAN
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Name | SHANTEL MARIE BASURTO
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Credential | LISW
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Telephone | 319-504-4593
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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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