NPIMap

Organization Active NPI

Tidemark Behavioral Health

  • Mental Health Counselor
  • West Chester, PA
National Provider Identifier
1164051025
Registry record updated Apr 3, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Health CounselorTaxonomy code 101YM0800X
Legal business name
TIDEMARK BEHAVIORAL HEALTH
Practice address
1272 Delmar Ave
West Chester, PA 19380-4027
Phone
(484) 432-7882
NPI assigned
Apr 3, 2020
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 3, 2020

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Ryne Laxton, LCSW-CNPI 1326469206
Title
Ceo
Phone
(484) 432-7882

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health CounselorGroup: 193200000X MULTI-SPECIALTY GROUP 101YM0800X Primary

Addresses

Primary practice location

1272 Delmar Ave
West Chester, PA 19380-4027

Mailing address

13 Ryan Frost Way
Essex, MD 21221-1646
Phone (484) 432-7882

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1585872000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1585872000000",
    "number": "1164051025",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "13 RYAN FROST WAY",
            "city": "ESSEX",
            "state": "MD",
            "postal_code": "212211646",
            "telephone_number": "484-432-7882"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1272 DELMAR AVE",
            "city": "WEST CHESTER",
            "state": "PA",
            "postal_code": "193804027",
            "telephone_number": "484-432-7882"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TIDEMARK BEHAVIORAL HEALTH",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-04-03",
        "last_updated": "2020-04-03",
        "certification_date": "2020-04-03",
        "status": "A",
        "authorized_official_last_name": "LAXTON",
        "authorized_official_first_name": "RYNE",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "484-432-7882",
        "authorized_official_credential": "LCSW-C"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor, Mental Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in West Chester, PA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 3, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.