Provider Demographics
NPI:1578041455
Name:MOUNTAIN VIEW THERAPY, LLC
Entity Type:Organization
Organization Name:MOUNTAIN VIEW THERAPY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:TAMARA
Authorized Official - Middle Name:
Authorized Official - Last Name:PORT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:540-208-5628
Mailing Address - Street 1:42 W COLONIAL HWY
Mailing Address - Street 2:
Mailing Address - City:HAMILTON
Mailing Address - State:VA
Mailing Address - Zip Code:20158-9007
Mailing Address - Country:US
Mailing Address - Phone:540-208-5628
Mailing Address - Fax:
Practice Address - Street 1:42 W COLONIAL HWY
Practice Address - Street 2:
Practice Address - City:HAMILTON
Practice Address - State:VA
Practice Address - Zip Code:20158-9007
Practice Address - Country:US
Practice Address - Phone:540-208-5628
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-08-01
Last Update Date:2018-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty