Provider Demographics
NPI:1477846566
Name:WESTERN SLOPE BEHAVIOR SERVICES, LLC
Entity Type:Organization
Organization Name:WESTERN SLOPE BEHAVIOR SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:MS
Authorized Official - First Name:AMANDA
Authorized Official - Middle Name:E
Authorized Official - Last Name:CHAFFIN
Authorized Official - Suffix:
Authorized Official - Credentials:BS
Authorized Official - Phone:970-424-4099
Mailing Address - Street 1:1570 45 1/2 RD
Mailing Address - Street 2:
Mailing Address - City:DE BEQUE
Mailing Address - State:CO
Mailing Address - Zip Code:81630-9633
Mailing Address - Country:US
Mailing Address - Phone:970-424-4099
Mailing Address - Fax:970-523-2079
Practice Address - Street 1:1570 45 1/2 RD
Practice Address - Street 2:
Practice Address - City:DE BEQUE
Practice Address - State:CO
Practice Address - Zip Code:81630-9633
Practice Address - Country:US
Practice Address - Phone:970-424-4099
Practice Address - Fax:970-523-2079
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-05-23
Last Update Date:2011-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty