Provider Demographics
NPI:1407321615
Name:MOUNTAIN MINDSET LLC
Entity Type:Organization
Organization Name:MOUNTAIN MINDSET LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:ANN
Authorized Official - Middle Name:
Authorized Official - Last Name:KENDIG
Authorized Official - Suffix:
Authorized Official - Credentials:LPCC LICDC
Authorized Official - Phone:513-601-8289
Mailing Address - Street 1:7686 CINCINNATI DAYTON RD STE A-4
Mailing Address - Street 2:
Mailing Address - City:WEST CHESTER
Mailing Address - State:OH
Mailing Address - Zip Code:45069-1539
Mailing Address - Country:US
Mailing Address - Phone:513-601-8289
Mailing Address - Fax:
Practice Address - Street 1:7686 CINCINNATI DAYTON RD STE A-4
Practice Address - Street 2:
Practice Address - City:WEST CHESTER
Practice Address - State:OH
Practice Address - Zip Code:45069-1539
Practice Address - Country:US
Practice Address - Phone:513-601-8289
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-10-04
Last Update Date:2018-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH13952735Medicaid