Provider Demographics
NPI:1487646279
Name:MOUNTAIN MENTAL HEALTH GROUP
Entity Type:Organization
Organization Name:MOUNTAIN MENTAL HEALTH GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:GENERAL PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:BARBARA
Authorized Official - Middle Name:
Authorized Official - Last Name:RICE
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:315-942-4252
Mailing Address - Street 1:PO BOX 211
Mailing Address - Street 2:
Mailing Address - City:BOONVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:13309-0211
Mailing Address - Country:US
Mailing Address - Phone:315-942-4252
Mailing Address - Fax:315-942-3207
Practice Address - Street 1:120 SCHUYLER ST
Practice Address - Street 2:
Practice Address - City:BOONVILLE
Practice Address - State:NY
Practice Address - Zip Code:13309-1005
Practice Address - Country:US
Practice Address - Phone:315-942-4252
Practice Address - Fax:315-942-3207
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY55921AMedicare ID - Type Unspecified