Provider Demographics
NPI:1578132429
Name:MOUNTAIN SPRINGS COUNSELING CENTER
Entity Type:Organization
Organization Name:MOUNTAIN SPRINGS COUNSELING CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COUNSELOR/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BETH
Authorized Official - Middle Name:
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:MA, LPC, RPT
Authorized Official - Phone:907-931-6928
Mailing Address - Street 1:290 N YENLO ST STE B5
Mailing Address - Street 2:
Mailing Address - City:WASILLA
Mailing Address - State:AK
Mailing Address - Zip Code:99654-7177
Mailing Address - Country:US
Mailing Address - Phone:907-931-6928
Mailing Address - Fax:907-931-7138
Practice Address - Street 1:290 N YENLO ST STE B5
Practice Address - Street 2:
Practice Address - City:WASILLA
Practice Address - State:AK
Practice Address - Zip Code:99654-7177
Practice Address - Country:US
Practice Address - Phone:907-931-6928
Practice Address - Fax:907-931-7138
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-06-23
Last Update Date:2024-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)