Provider Demographics
NPI:1619401734
Name:BLUE MOUNTAIN NEUROPSYCHOLOGICAL ASSOCIATES, PS
Entity Type:Organization
Organization Name:BLUE MOUNTAIN NEUROPSYCHOLOGICAL ASSOCIATES, PS
Other - Org Name:BLUE MOUNTAIN PSYCHOLOGY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT & EXECUTIVE DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMESON
Authorized Official - Middle Name:C
Authorized Official - Last Name:LONTZ
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:509-939-6863
Mailing Address - Street 1:1624 W DEAN AVE
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99201-1825
Mailing Address - Country:US
Mailing Address - Phone:509-939-6863
Mailing Address - Fax:509-464-6463
Practice Address - Street 1:1624 W DEAN AVE
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99201-1825
Practice Address - Country:US
Practice Address - Phone:509-939-6863
Practice Address - Fax:509-464-6463
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-04-14
Last Update Date:2017-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPY60040765103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty