| Beyond Behavioral Health Llc | |
|
104 S Freya St Bldg Suite210 Spokane WA 99202-4862 | |
| (509) 964-1590 | |
| Not Available |
| Full Name | Beyond Behavioral Health Llc |
|---|---|
| Speciality | Counselor |
| Location | 104 S Freya St Bldg Suite210, Spokane, Washington |
| Authorized Official Name and Position | Angela M Mello (ADMINISTRATOR) |
| Authorized Official Contact | 5099641590 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Beyond Behavioral Health Llc 104 S Freya St Ste 210 Spokane WA 99202-4871 Ph: (509) 964-1590 | Beyond Behavioral Health Llc 104 S Freya St Bldg Suite210 Spokane WA 99202-4862 Ph: (509) 964-1590 |
| NPI Number | 1033728415 |
|---|---|
| Provider Enumeration Date | 07/30/2020 |
| Last Update Date | 08/18/2020 |
| Certification Date | 08/18/2020 |
| Medicare PECOS PAC ID | 3274951579 |
|---|---|
| Medicare Enrollment ID | O20200918001273 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1033728415 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YA0400X | Counselor - Addiction (substance Use Disorder) | (* (Not Available)) | Secondary |
| 101YM0800X | Counselor - Mental Health | (* (Not Available)) | Primary |
| Provider Name | Jason Edward Vestal |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1851899215 PECOS PAC ID: 8820359235 Enrollment ID: I20180228000183 |
| Provider Name | Angela Marie Mello |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1609171446 PECOS PAC ID: 4183042484 Enrollment ID: I20200921000827 |
| Provider Name | Raymond G Fredrickson |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1902495351 PECOS PAC ID: 4284001702 Enrollment ID: I20221111001900 |
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