NPIMap

Organization Active NPI

Behavioral Health Resources

  • Community/Behavioral Health Agency
  • Shelton, WA
National Provider Identifier
1194896654
Registry record updated Dec 27, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Behavioral Health AgencyTaxonomy code 251S00000X
License
600144953 Issued in WA
Legal business name
BEHAVIORAL HEALTH RESOURCES
Practice address
110 W K St
Shelton, WA 98584-2939
Phone
(360) 426-1696
Fax
(360) 427-0357
NPI assigned
Nov 13, 2006
Last updated
Dec 27, 2019By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 27, 2019

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

Authorized official

Name
Eric Jensen
Title
Controller
Phone
(360) 236-7170

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Community/Behavioral Health Agency 251S00000X 600144953 WA Primary

Addresses

Primary practice location

110 W K St
Shelton, WA 98584-2939

Mailing address

3857 Martin Way E
Olympia, WA 98506-5268
Phone (360) 704-7170

Other identifiers 1

IdentifierTypeStateIssuer
1993088MedicaidWA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040119000614 WA Part B Supplier - Clinic/Group Practice 7315848660 Receives reassigned benefits from 8 practitioners
8 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Elma, WA; Shelton, WA; Olympia, WA; Hoquiam, WA

Other NPIs on the same Medicare enrollment 8

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory
Tax ID family
Beharioral Health Resou8 organizations share this tax ID, including this one

Other organizations with this tax ID 7

Organizations that report the same tax identification number in the National Provider Directory.

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1163376000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1577404800000",
    "number": "1194896654",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3857 MARTIN WAY E",
            "city": "OLYMPIA",
            "state": "WA",
            "postal_code": "985065268",
            "telephone_number": "360-704-7170",
            "fax_number": "360-709-4374"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "110 W K ST",
            "city": "SHELTON",
            "state": "WA",
            "postal_code": "985842939",
            "telephone_number": "360-426-1696",
            "fax_number": "360-427-0357"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BEHAVIORAL HEALTH RESOURCES",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-13",
        "last_updated": "2019-12-27",
        "certification_date": "2019-12-27",
        "status": "A",
        "authorized_official_last_name": "JENSEN",
        "authorized_official_first_name": "ERIC",
        "authorized_official_title_or_position": "CONTROLLER",
        "authorized_official_telephone_number": "360-236-7170"
    },
    "taxonomies": [
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": "WA",
            "license": "600144953",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1993088",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Shelton, WA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 27, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.