BEACON BEHAVIORAL HEALTH SERVICES (NPI# 1912243148) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1912243148 |
| Entity Type | Organization |
| Organization Name | BEACON BEHAVIORAL HEALTH SERVICES |
| Practice Address |
102 W Beaton Dr Suite 103 West Fargo ND 58078-2652 |
| Practice Telephone | 7013561276 |
| Practice Fax Number | 7013564940 |
| Mailing Telephone | 7013561276 |
| Mailing Fax Number | 7013564940 |
| Enumeration Date | 2012-12-16 |
| Last Update Date | 2012-12-16 |
| Authorized Official Name | KARLA BUSKIRK (OFFICE MANAGER) |
| Authorized Official Telephone | 7013561276 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 103TC2200X |
Psychologist Specialization: Clinical Child & Adolescent |
421 | ND | Behavioral Health & Social Service Providers |
| Y | 103TC2200X |
Psychologist Specialization: Clinical Child & Adolescent |
372 | ND | Behavioral Health & Social Service Providers |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1649659426 | Beacon Behavioral Health Services | Clinic/Center | 154 Cooper Rd, Suite 801, West Berlin, NJ 08091-9128 | 2015-05-26 |
| Street Address |
102 W BEATON DR SUITE 103 |
| City | WEST FARGO |
| State | ND |
| Zip Code | 58078-2652 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1497805196 | Great Kids Therapy, Ltd. | Physical Therapist | 102 W Beaton Dr, Suite 100, West Fargo, ND 58078-2652 | 2007-01-12 |
| 1790296754 | Marce J Otterson | Physical Therapist | 102 W Beaton Dr, West Fargo, ND 58078 | 2017-10-18 |
| 1558743013 | Great Kids Therapy, Ltd | Occupational Therapist | 102 W Beaton Dr, Suite 105, West Fargo, ND 58078-2652 | 2015-06-22 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1982205068 | Ashley Kasson Therapy | Counselor | 3220 4th St E, West Fargo, ND 58078 | 2020-11-04 |
| 1427658624 | Deedee (dorin) Ngwe | Technician | 3240 9th S West Apt. 204, West Fargo, ND 58078 | 2020-10-27 |
| 1053879734 | Mpnd,inc | Pharmacy | 2050 Sheyenne Street, West Fargo, ND 58078 | 2019-03-12 |
| 1396239216 | Luke Gable | Behavior Technician | 647 13th Avenue South, West Fargo, ND 58078 | 2018-06-15 |
| 1629597919 | Cody Freng | Specialist/Technologist | 3276 9th St W Apt C, West Fargo, ND 58078 | 2017-09-18 |
| 1831613942 | Lauren Phyllis Loe | Physical Therapist | 1401 13th Avenue East, Essentia Health West Fargo Clinic, West Fargo, ND 58078 | 2017-07-31 |
| 1851746226 | Jodi Kilen | Occupational Therapy Assistant | 631 4th Ave East, West Fargo, ND 58078 | 2016-05-04 |
| 1922490101 | Betty Ann Helmer | Social Worker | 2355 Meadow Ridge Parkway, West Fargo, ND 58078 | 2015-02-25 |
| 1477972784 | Tessa Nicole Larson | Occupational Therapist | 3139 Bluestem Dr Ste 108, West Fargo, ND 58078 | 2014-04-15 |
| 1023432010 | Kaylyn Kortes | Licensed Practical Nurse | 1302 Sheyenne St, West Fargo, ND 58078 | 2014-02-11 |
| Find all providers in zip 58078 | ||||
| Taxonomy Code | 103TC2200X |
| Grouping | Behavioral Health & Social Service Providers |
| Classification | Psychologist |
| Specialization | Clinical Child & Adolescent |
| Definition to come... |
| Notes: [1/1/2007: title modified] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1225579840 | Kathleen Suzanne Tillman | Psychologist | 2100 S Columbia Road, Suite 202, Family Institute, PC, Grand Forks, ND 58201 | 2017-03-15 |
| 1093757791 | Carita R Shawchuck | Psychologist | 1121 Westrac Dr S, Suite 204, Fargo, ND 58103-8716 | 2006-06-10 |
| 1437715166 | Diana Rose Slivensky | Psychologist | 100 4th St S, Fargo, ND 58103-1929 | 2019-05-17 |
| 1609205988 | Robyn Maley | Psychologist | 100 4th St S, Fargo, ND 58103-1929 | 2013-11-06 |
| 1649604869 | Daniel Barrett Landauer | Psychologist | 1711 University Dr S, Fargo, ND 58103-4939 | 2013-08-23 |
| 1013269257 | Carita R Shawchuck, Phd, PC | Psychologist | 1121 Westrac Dr S Ste 204, Fargo, ND 58103-2385 | 2012-10-12 |
| 1962782268 | Sanford Medical Center Fargo | Psychologist | 100 4th St S, Fargo, ND 58103-1929 | 2011-08-18 |
| 1972756583 | Shyla L Muse | Psychologist | 3535 S 31st St Ste 201, Grand Forks, ND 58201 | 2008-10-28 |
| 1124218961 | Sanford Clinic North | Psychologist | 100 4th St S, Fargo, ND 58103-1929 | 2007-07-27 |
| 1871650267 | Carita R Shawchuck Phd PC | Psychologist | 1351 Page Dr S, Suite 105, Fargo, ND 58103-3502 | 2007-01-03 |
| Find all providers with the same taxonomy | ||||
| City | WEST FARGO |
| Zip Code | 58078 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.