Beacon Behavioral Health Services

Primary specialty

Clinical Child & Adolescent PsychologistTaxonomy code 103TC2200X

License

372 Issued in ND

Legal business name

BEACON BEHAVIORAL HEALTH SERVICES

Practice address

102 W Beaton Dr
Suite 103
West Fargo, ND 58078-2652

Phone

(701) 356-1276

Fax

(701) 356-4940

NPI assigned

Dec 16, 2012

Organization subpart

No

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

Authorized official

Name

Karla Buskirk

Title

Office Manager

Phone

(701) 356-1276

Specialties & licenses 2

Addresses

Locations

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

{
    "created_epoch": "1355616000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1355616000000",
    "number": "1912243148",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "102 W BEATON DR",
            "address_2": "SUITE 103",
            "city": "WEST FARGO",
            "state": "ND",
            "postal_code": "580782652",
            "telephone_number": "701-356-1276",
            "fax_number": "701-356-4940"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "102 W BEATON DR",
            "address_2": "SUITE 103",
            "city": "WEST FARGO",
            "state": "ND",
            "postal_code": "580782652",
            "telephone_number": "701-356-1276",
            "fax_number": "701-356-4940"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BEACON BEHAVIORAL HEALTH SERVICES",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-12-16",
        "last_updated": "2012-12-16",
        "status": "A",
        "authorized_official_last_name": "BUSKIRK",
        "authorized_official_first_name": "KARLA",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "701-356-1276"
    },
    "taxonomies": [
        {
            "code": "103TC2200X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Psychologist, Clinical Child & Adolescent",
            "state": "ND",
            "license": "372",
            "primary": true
        },
        {
            "code": "103TC2200X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Psychologist, Clinical Child & Adolescent",
            "state": "ND",
            "license": "421",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Clinical Child & Adolescent Psychologist in North Dakota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 16, 2012; 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.