| Organization Name: | CBASS-AXIS INC. |
| NPI Number: | 1326461757 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | HAROLD MANGRUM (CEO) |
| Mailing Address: | 4444 W. Pine Blvd. # 423 St.louis |
| State: | MO US |
| Postal Code: | 63108 |
| Phone Number: | 3142959862 |
| Fax Number: | |
| NPI Enumeration Date: | 01/21/2014 |
| NPI Last Update Date: | 01/21/2014 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YA0400X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Addiction (Substance Use Disorder) |
| Taxonomy Definition: | |