Provider Demographics
NPI:1437693835
Name:MOUNTAIN CREST COUNSELING PC
Entity Type:Organization
Organization Name:MOUNTAIN CREST COUNSELING PC
Other - Org Name:REBECCA MANN, LCSW
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:SHAREHOLDER/ THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:REBECCA
Authorized Official - Middle Name:E
Authorized Official - Last Name:MANN
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:406-880-2352
Mailing Address - Street 1:PO BOX 243
Mailing Address - Street 2:
Mailing Address - City:HAMILTON
Mailing Address - State:MT
Mailing Address - Zip Code:59840-0243
Mailing Address - Country:US
Mailing Address - Phone:406-880-2352
Mailing Address - Fax:
Practice Address - Street 1:310 N 4TH ST
Practice Address - Street 2:SUITE D
Practice Address - City:HAMILTON
Practice Address - State:MT
Practice Address - Zip Code:59840-2412
Practice Address - Country:US
Practice Address - Phone:406-880-2352
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-12-05
Last Update Date:2016-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT49231041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty