Provider Demographics
NPI:1194485326
Name:ASCENT WELLNESS, LLC
Entity type:Organization
Organization Name:ASCENT WELLNESS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DEANNA
Authorized Official - Middle Name:FAYE
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:LICSW
Authorized Official - Phone:320-496-3835
Mailing Address - Street 1:25660 3RD ST W APT 214
Mailing Address - Street 2:
Mailing Address - City:ZIMMERMAN
Mailing Address - State:MN
Mailing Address - Zip Code:55398-4587
Mailing Address - Country:US
Mailing Address - Phone:320-496-3835
Mailing Address - Fax:
Practice Address - Street 1:25660 3RD ST W APT 214
Practice Address - Street 2:
Practice Address - City:ZIMMERMAN
Practice Address - State:MN
Practice Address - Zip Code:55398-4587
Practice Address - Country:US
Practice Address - Phone:320-496-3835
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-12-29
Last Update Date:2021-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)