Provider Demographics
NPI:1184854689
Name:MOUNTAINS EDGE COUNSELING, LLC
Entity Type:Organization
Organization Name:MOUNTAINS EDGE COUNSELING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:B
Authorized Official - Last Name:JONES-ROBINSON
Authorized Official - Suffix:
Authorized Official - Credentials:LPC, LAT,MAC
Authorized Official - Phone:307-673-4647
Mailing Address - Street 1:406 W LOUCKS ST
Mailing Address - Street 2:
Mailing Address - City:SHERIDAN
Mailing Address - State:WY
Mailing Address - Zip Code:82801-4129
Mailing Address - Country:US
Mailing Address - Phone:307-673-4647
Mailing Address - Fax:307-674-1724
Practice Address - Street 1:406 W LOUCKS ST
Practice Address - Street 2:
Practice Address - City:SHERIDAN
Practice Address - State:WY
Practice Address - Zip Code:82801-4129
Practice Address - Country:US
Practice Address - Phone:307-673-4647
Practice Address - Fax:307-674-1724
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-17
Last Update Date:2013-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WYLPC - 790101Y00000X, 261QM0855X
WYLPC 790252Y00000X
WYLAT - 294261QR0405X
WYLPC-7903245S0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Multi-Specialty
No252Y00000XAgenciesEarly Intervention Provider Agency
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health
No261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder
No3245S0500XResidential Treatment FacilitiesSubstance Abuse Rehabilitation FacilitySubstance Abuse Treatment, ChildrenGroup - Multi-Specialty