Provider Demographics
NPI:1942698246
Name:VICTORY MOUNTAIN PSYCHOTHERAPY, INC
Entity Type:Organization
Organization Name:VICTORY MOUNTAIN PSYCHOTHERAPY, INC
Other - Org Name:VICTORY CHRISTIAN COUNSELING, INC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:CEO/OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:
Authorized Official - Last Name:SUMPOLEC
Authorized Official - Suffix:
Authorized Official - Credentials:LPCC
Authorized Official - Phone:540-842-4999
Mailing Address - Street 1:18565 SOLEDAD CANYON ROAD
Mailing Address - Street 2:BOX 302
Mailing Address - City:CANYON COUNTRY
Mailing Address - State:CA
Mailing Address - Zip Code:91351-3700
Mailing Address - Country:US
Mailing Address - Phone:540-842-4999
Mailing Address - Fax:540-371-8428
Practice Address - Street 1:27659 BURGUNDY CROSSING LANE
Practice Address - Street 2:
Practice Address - City:CANYON COUNTRY
Practice Address - State:CA
Practice Address - Zip Code:91351
Practice Address - Country:US
Practice Address - Phone:540-842-4999
Practice Address - Fax:540-371-8428
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-08
Last Update Date:2024-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701003590251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health