Provider Demographics
NPI:1104367366
Name:MOUNTAIN ROSE COUNSELING
Entity Type:Organization
Organization Name:MOUNTAIN ROSE COUNSELING
Other - Org Name:MOUNTAIN ROSE COUNSELING FOR EMOTIONAL HEALTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:MIRANDA
Authorized Official - Middle Name:DEE
Authorized Official - Last Name:CALHOUN
Authorized Official - Suffix:
Authorized Official - Credentials:MA LPCC
Authorized Official - Phone:720-495-1616
Mailing Address - Street 1:4855 EDISON AVE APT 114
Mailing Address - Street 2:
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80301-5429
Mailing Address - Country:US
Mailing Address - Phone:720-495-1616
Mailing Address - Fax:
Practice Address - Street 1:260 S 112TH ST
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:CO
Practice Address - Zip Code:80026-9031
Practice Address - Country:US
Practice Address - Phone:303-647-5950
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-20
Last Update Date:2017-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COLPCC.0015196305S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305S00000XManaged Care OrganizationsPoint of Service