Provider Demographics
NPI:1083005979
Name:BLUE MOUNTAIN NEUROPSYCHOLOGICAL ASSOCIATES
Entity Type:Organization
Organization Name:BLUE MOUNTAIN NEUROPSYCHOLOGICAL ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JAMESON
Authorized Official - Middle Name:
Authorized Official - Last Name:LONTZ
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:509-939-0719
Mailing Address - Street 1:1624 W DEAN AVE
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99201-1825
Mailing Address - Country:US
Mailing Address - Phone:509-939-0719
Mailing Address - Fax:509-464-6463
Practice Address - Street 1:1624 W DEAN AVE
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99201-1825
Practice Address - Country:US
Practice Address - Phone:509-939-0719
Practice Address - Fax:509-464-6463
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-02-12
Last Update Date:2016-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPY60040765103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty