Provider Demographics
NPI:1093315764
Name:MOUNTAIN VISTA PSYCHOLOGY, PLLC
Entity Type:Organization
Organization Name:MOUNTAIN VISTA PSYCHOLOGY, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:TARA
Authorized Official - Middle Name:
Authorized Official - Last Name:MCCONNELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:720-583-9332
Mailing Address - Street 1:6635 S DAYTON ST STE 140
Mailing Address - Street 2:
Mailing Address - City:GREENWOOD VILLAGE
Mailing Address - State:CO
Mailing Address - Zip Code:80111-6109
Mailing Address - Country:US
Mailing Address - Phone:720-583-9332
Mailing Address - Fax:
Practice Address - Street 1:6635 S DAYTON ST STE 140
Practice Address - Street 2:
Practice Address - City:GREENWOOD VILLAGE
Practice Address - State:CO
Practice Address - Zip Code:80111-6109
Practice Address - Country:US
Practice Address - Phone:720-583-9332
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-10-30
Last Update Date:2023-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty