Provider Demographics
NPI:1255890844
Name:TIMBERLINE BEHAVIORAL HEALTH, LLC
Entity type:Organization
Organization Name:TIMBERLINE BEHAVIORAL HEALTH, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SARAH
Authorized Official - Middle Name:RAEGHAN
Authorized Official - Last Name:DESSEL
Authorized Official - Suffix:
Authorized Official - Credentials:MA, BCBA
Authorized Official - Phone:970-821-7323
Mailing Address - Street 1:291 MEADOWS CIR
Mailing Address - Street 2:
Mailing Address - City:BAYFIELD
Mailing Address - State:CO
Mailing Address - Zip Code:81122-9506
Mailing Address - Country:US
Mailing Address - Phone:970-821-7323
Mailing Address - Fax:
Practice Address - Street 1:291 MEADOWS CIR
Practice Address - Street 2:
Practice Address - City:BAYFIELD
Practice Address - State:CO
Practice Address - Zip Code:81122-9506
Practice Address - Country:US
Practice Address - Phone:970-821-7323
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-03-14
Last Update Date:2023-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO9000152754Medicaid