Provider Demographics
NPI:1093567430
Name:BLUE MOUNTAIN COUNSELING, LLC
Entity Type:Organization
Organization Name:BLUE MOUNTAIN COUNSELING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:VIRGINIA
Authorized Official - Middle Name:
Authorized Official - Last Name:RUSY
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:970-361-2088
Mailing Address - Street 1:743 HORIZON CT STE 310-B
Mailing Address - Street 2:
Mailing Address - City:GRAND JCT
Mailing Address - State:CO
Mailing Address - Zip Code:81506-8701
Mailing Address - Country:US
Mailing Address - Phone:970-361-2088
Mailing Address - Fax:844-888-1231
Practice Address - Street 1:743 HORIZON CT STE 310-B
Practice Address - Street 2:
Practice Address - City:GRAND JCT
Practice Address - State:CO
Practice Address - Zip Code:81506-8701
Practice Address - Country:US
Practice Address - Phone:970-361-2088
Practice Address - Fax:844-888-1231
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-04-01
Last Update Date:2024-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1265967095OtherNPI