Provider Demographics
| NPI: | 1861495327 |
|---|---|
| Name: | FRONTIER BEHAVIORAL HEALTH |
| Entity Type: | Organization |
| Organization Name: | FRONTIER BEHAVIORAL HEALTH |
| Other - Org Name: | |
| Other - Org Type: | |
| Authorized Official - Title/Position: | CFO |
| Authorized Official - Prefix: | MR |
| Authorized Official - First Name: | CRAIG |
| Authorized Official - Middle Name: | R |
| Authorized Official - Last Name: | DUNLAP |
| Authorized Official - Suffix: | |
| Authorized Official - Credentials: | |
| Authorized Official - Phone: | 509-838-4651 |
| Mailing Address - Street 1: | 107 S DIVISION ST |
| Mailing Address - Street 2: | |
| Mailing Address - City: | SPOKANE |
| Mailing Address - State: | WA |
| Mailing Address - Zip Code: | 99202-1510 |
| Mailing Address - Country: | US |
| Mailing Address - Phone: | 509-838-4651 |
| Mailing Address - Fax: | 509-363-2762 |
| Practice Address - Street 1: | 107 S DIVISION ST |
| Practice Address - Street 2: | |
| Practice Address - City: | SPOKANE |
| Practice Address - State: | WA |
| Practice Address - Zip Code: | 99202 |
| Practice Address - Country: | US |
| Practice Address - Phone: | 509-838-4651 |
| Practice Address - Fax: | 509-363-2762 |
| EIN: | <UNAVAIL> |
| Is Organization Subpart?: | No |
| Parent Organization LBN: | |
| Parent Organization TIN: | |
| Enumeration Date: | 2005-05-27 |
| Last Update Date: | 2018-06-28 |
| Deactivation Date: | |
| Deactivation Code: | |
| Reactivation Date: |
Provider Licenses
| State | License ID | Taxonomies |
|---|---|---|
| WA | 001 | 101YM0800X, 104100000X, 1041C0700X, 106H00000X, 251S00000X, 363L00000X, 363LF0000X, 363LP0808X, 364SP0808X, 364SP0809X |
| 103T00000X, 2084P0800X, 364S00000X | ||
| WA | 2084P0804X, 208D00000X |
Provider Taxonomies
| Primary? | Code | Type | Classification | Specialization | Group |
|---|---|---|---|---|---|
| Yes | 251S00000X | Agencies | Community/Behavioral Health | Group - Multi-Specialty | |
| No | 101YM0800X | Behavioral Health & Social Service Providers | Counselor | Mental Health | Group - Multi-Specialty |
| No | 103T00000X | Behavioral Health & Social Service Providers | Psychologist | Group - Multi-Specialty | |
| No | 104100000X | Behavioral Health & Social Service Providers | Social Worker | Group - Multi-Specialty | |
| No | 1041C0700X | Behavioral Health & Social Service Providers | Social Worker | Clinical | Group - Multi-Specialty |
| No | 106H00000X | Behavioral Health & Social Service Providers | Marriage & Family Therapist | Group - Multi-Specialty | |
| No | 2084P0800X | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Psychiatry | Group - Multi-Specialty |
| No | 2084P0804X | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Child & Adolescent Psychiatry | Group - Multi-Specialty |
| No | 208D00000X | Allopathic & Osteopathic Physicians | General Practice | Group - Multi-Specialty | |
| No | 363L00000X | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Group - Multi-Specialty | |
| No | 363LF0000X | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family | Group - Multi-Specialty |
| No | 363LP0808X | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Psychiatric/Mental Health | Group - Multi-Specialty |
| No | 364S00000X | Physician Assistants & Advanced Practice Nursing Providers | Clinical Nurse Specialist | Group - Multi-Specialty | |
| No | 364SP0808X | Physician Assistants & Advanced Practice Nursing Providers | Clinical Nurse Specialist | Psychiatric/Mental Health | Group - Multi-Specialty |
| No | 364SP0809X | Physician Assistants & Advanced Practice Nursing Providers | Clinical Nurse Specialist | Psychiatric/Mental Health, Adult | Group - Multi-Specialty |
Provider Identifiers
| State | Identifier ID | ID Type | Issuer |
|---|---|---|---|
| WA | 7111396 | Medicaid | |
| WA | 000347100 | Medicare Oscar/Certification |
