Provider Demographics
NPI:1326515800
Name:MOUNTAIN SPRING WELLNESS LLC
Entity Type:Organization
Organization Name:MOUNTAIN SPRING WELLNESS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOTHERAPIST/OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:ERICK
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:LATTRELL
Authorized Official - Suffix:
Authorized Official - Credentials:LICSW
Authorized Official - Phone:802-310-6089
Mailing Address - Street 1:PO BOX 734
Mailing Address - Street 2:
Mailing Address - City:WATERBURY
Mailing Address - State:VT
Mailing Address - Zip Code:05676-0734
Mailing Address - Country:US
Mailing Address - Phone:802-310-6089
Mailing Address - Fax:
Practice Address - Street 1:1617 DOWSVILLE RD
Practice Address - Street 2:
Practice Address - City:SOUTH DUXBURY
Practice Address - State:VT
Practice Address - Zip Code:05660-9165
Practice Address - Country:US
Practice Address - Phone:802-310-6089
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-11-01
Last Update Date:2021-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty