Provider Demographics
NPI:1063293082
Name:FRESH START BEHAVIORAL HEALTH LLC
Entity type:Organization
Organization Name:FRESH START BEHAVIORAL HEALTH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MOHAMED
Authorized Official - Middle Name:
Authorized Official - Last Name:BAH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:713-748-5086
Mailing Address - Street 1:3744 ARMAND DR
Mailing Address - Street 2:
Mailing Address - City:DICKINSON
Mailing Address - State:TX
Mailing Address - Zip Code:77539-4461
Mailing Address - Country:US
Mailing Address - Phone:509-418-5216
Mailing Address - Fax:
Practice Address - Street 1:601 W 1ST AVE
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99201-3825
Practice Address - Country:US
Practice Address - Phone:509-418-5216
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-10-06
Last Update Date:2024-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty