MEDICARE: CLIMB BEHAVIORAL SOLUTIONS, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103K00000X	Behavior Analyst

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1790118552	OTHER	OR	NPI TYPE 1
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1588276364
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CLIMB BEHAVIORAL SOLUTIONS, LLC

Provider Business Mailing Address
First Line	:	2614 SE 28TH AVE
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97202-1311
Country	:	US
Telephone Number	:	864-621-7408
Fax Number	:	503-802-5351

Provider Business Practice Location Address
First Line	:	809B SE SHERMAN ST
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97214-4666
Country	:	US
Telephone Number	:	864-621-7408
Fax Number	:	503-802-5351

Authorized Official
Title or Position	:	OWNER/FOUNDER
Name	:	CASEY L MARIN-SHOVER
Credential	:	MA, BCBA, LBA
Telephone Number	:	864-621-7408

Provider Enumeration Date	:	08/21/2020
Last Update Date	:	08/21/2020

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