Provider Demographics
NPI:1588109953
Name:ACHIEVE BEHAVIORAL HEALTH
Entity type:Organization
Organization Name:ACHIEVE BEHAVIORAL HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JUDSON
Authorized Official - Middle Name:
Authorized Official - Last Name:COOK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:845-321-2049
Mailing Address - Street 1:2001 S GARNETT RD
Mailing Address - Street 2:SUITE G
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74128-1836
Mailing Address - Country:US
Mailing Address - Phone:845-321-2049
Mailing Address - Fax:
Practice Address - Street 1:1420 VANCE ST
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80214-4285
Practice Address - Country:US
Practice Address - Phone:845-321-2049
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-12-21
Last Update Date:2017-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251S00000XAgenciesCommunity/Behavioral Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO000000000Medicaid