Basic Information
Provider Information | |||||||||
NPI: | 1164739215 | ||||||||
EntityType: | 2 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: | MOUNTAIN COUNSELING & TRAINING, INC. | ||||||||
LastName: |   | ||||||||
FirstName: |   | ||||||||
MiddleName: |   | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: |   | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | PO BOX 6300 | ||||||||
Address2: |   | ||||||||
City: | CRESTLINE | ||||||||
State: | CA | ||||||||
PostalCode: | 92325 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 9092737714 | ||||||||
FaxNumber: | 9513004719 | ||||||||
Practice Location | |||||||||
Address1: | 340 HWY 138 | ||||||||
Address2: |   | ||||||||
City: | CRESTLINE | ||||||||
State: | CA | ||||||||
PostalCode: | 92325 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 9093363330 | ||||||||
FaxNumber: | 9513004719 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 09/10/2010 | ||||||||
LastUpdateDate: | 05/12/2022 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: |   | ||||||||
AuthorizedOfficialLastName: | HARRINGTON | ||||||||
AuthorizedOfficialFirstName: | ANGELA | ||||||||
AuthorizedOfficialMiddleName: | MARGUERITE | ||||||||
AuthorizedOfficialTitleorPosition: | INTERIM CEO | ||||||||
AuthorizedOfficialTelephone: | 9092737714 | ||||||||
IsSoleProprietor: |   | ||||||||
IsOrganizationSubpart: | N | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: | 05/12/2022 |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 390200000X |   |   | Y | 193400000X SINGLE SPECIALTY GROUP | Student, Health Care | Student in an Organized Health Care Education/Training Program |   |
No ID Information.