Provider Demographics
NPI:1174102925
Name:ASCENT BEHAVIORAL ANALYSIS, PLLC
Entity type:Organization
Organization Name:ASCENT BEHAVIORAL ANALYSIS, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SHELLEY
Authorized Official - Middle Name:
Authorized Official - Last Name:BURBANK
Authorized Official - Suffix:
Authorized Official - Credentials:BCBA
Authorized Official - Phone:406-442-6396
Mailing Address - Street 1:2685 AIRPORT RD
Mailing Address - Street 2:
Mailing Address - City:HELENA
Mailing Address - State:MT
Mailing Address - Zip Code:59601-1262
Mailing Address - Country:US
Mailing Address - Phone:406-442-6396
Mailing Address - Fax:406-442-6897
Practice Address - Street 1:2685 AIRPORT RD
Practice Address - Street 2:
Practice Address - City:HELENA
Practice Address - State:MT
Practice Address - Zip Code:59601-1262
Practice Address - Country:US
Practice Address - Phone:406-442-6396
Practice Address - Fax:406-442-6897
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-04-07
Last Update Date:2024-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty
No106S00000XBehavioral Health & Social Service ProvidersBehavior TechnicianGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT7259278Medicaid