Provider Demographics
NPI:1356498638
Name:MOUNTAIN VALLEY MENTAL HEALTH PROGRAMS, INC.
Entity Type:Organization
Organization Name:MOUNTAIN VALLEY MENTAL HEALTH PROGRAMS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:VICKI
Authorized Official - Middle Name:
Authorized Official - Last Name:LONG
Authorized Official - Suffix:
Authorized Official - Credentials:MS
Authorized Official - Phone:541-523-3646
Mailing Address - Street 1:2200 4TH ST
Mailing Address - Street 2:
Mailing Address - City:BAKER CITY
Mailing Address - State:OR
Mailing Address - Zip Code:97814-2615
Mailing Address - Country:US
Mailing Address - Phone:541-523-3646
Mailing Address - Fax:541-523-7602
Practice Address - Street 1:2200 4TH ST
Practice Address - Street 2:
Practice Address - City:BAKER CITY
Practice Address - State:OR
Practice Address - Zip Code:97814-2615
Practice Address - Country:US
Practice Address - Phone:541-523-3646
Practice Address - Fax:541-523-7602
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR131284Medicare ID - Type Unspecified