Provider Demographics
NPI:1497330401
Name:BLUE MOUNTAIN THERAPY, LLC
Entity Type:Organization
Organization Name:BLUE MOUNTAIN THERAPY, LLC
Other - Org Name:BLUE MOUNTAIN THERAPY ABA
Other - Org Type:Other Name
Authorized Official - Title/Position:HR
Authorized Official - Prefix:
Authorized Official - First Name:MELISSA
Authorized Official - Middle Name:HOPE
Authorized Official - Last Name:HENDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:276-525-4460
Mailing Address - Street 1:17507 LEE HWY
Mailing Address - Street 2:
Mailing Address - City:ABINGDON
Mailing Address - State:VA
Mailing Address - Zip Code:24210-7835
Mailing Address - Country:US
Mailing Address - Phone:276-525-6043
Mailing Address - Fax:
Practice Address - Street 1:17507 LEE HWY
Practice Address - Street 2:
Practice Address - City:ABINGDON
Practice Address - State:VA
Practice Address - Zip Code:24210-7835
Practice Address - Country:US
Practice Address - Phone:276-525-6043
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BLUE MOUNTAIN THERAPY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-03-11
Last Update Date:2021-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Multi-Specialty
No106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior AnalystGroup - Multi-Specialty
No106S00000XBehavioral Health & Social Service ProvidersBehavior TechnicianGroup - Multi-Specialty