Provider Demographics
NPI:1265702997
Name:ORION BEHAVIORAL HEALTH NETWORK LLC
Entity type:Organization
Organization Name:ORION BEHAVIORAL HEALTH NETWORK LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:ELLEN
Authorized Official - Last Name:DESRUISSEAU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:907-360-1566
Mailing Address - Street 1:200 2ND AVE S # 489
Mailing Address - Street 2:
Mailing Address - City:SAINT PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33701-4313
Mailing Address - Country:US
Mailing Address - Phone:907-360-1566
Mailing Address - Fax:907-726-0032
Practice Address - Street 1:16600 CENTERFIELD DR STE 4
Practice Address - Street 2:
Practice Address - City:EAGLE RIVER
Practice Address - State:AK
Practice Address - Zip Code:99577-7702
Practice Address - Country:US
Practice Address - Phone:907-696-7466
Practice Address - Fax:907-726-0332
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-11
Last Update Date:2025-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK9352672080P0006X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2080P0006XAllopathic & Osteopathic PhysiciansPediatricsDevelopmental - Behavioral PediatricsGroup - Single Specialty