Provider Demographics
NPI:1245567098
Name:BEACON BEHAVIORAL HEALTHCARE
Entity Type:Organization
Organization Name:BEACON BEHAVIORAL HEALTHCARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:BETH
Authorized Official - Middle Name:
Authorized Official - Last Name:RUSSELL
Authorized Official - Suffix:
Authorized Official - Credentials:MAOA, MA, CIT
Authorized Official - Phone:913-254-1993
Mailing Address - Street 1:13505 S MUR LEN RD
Mailing Address - Street 2:STE.105, PMB #331
Mailing Address - City:OLATHE
Mailing Address - State:KS
Mailing Address - Zip Code:66062-1600
Mailing Address - Country:US
Mailing Address - Phone:913-254-1993
Mailing Address - Fax:913-499-1490
Practice Address - Street 1:801 W 97TH ST
Practice Address - Street 2:SUMMIT VIEW CHURCH OF THE NAZARENE
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64114-3942
Practice Address - Country:US
Practice Address - Phone:913-254-1993
Practice Address - Fax:913-499-1490
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-11-14
Last Update Date:2009-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health