Provider Demographics
NPI:1972267292
Name:EAGLE VALLEY MENTAL HEALTH
Entity Type:Organization
Organization Name:EAGLE VALLEY MENTAL HEALTH
Other - Org Name:EAGLE VALLEY BEHAVIORAL HEALTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIR COMMUNITY BEHAVIORAL HEALTH
Authorized Official - Prefix:DR
Authorized Official - First Name:CASEY
Authorized Official - Middle Name:
Authorized Official - Last Name:WOLFINGTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:970-569-7765
Mailing Address - Street 1:PO BOX 843056
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64184-3056
Mailing Address - Country:US
Mailing Address - Phone:970-777-2850
Mailing Address - Fax:
Practice Address - Street 1:429 EDWARDS ACCESS RD
Practice Address - Street 2:
Practice Address - City:EDWARDS
Practice Address - State:CO
Practice Address - Zip Code:81632-5524
Practice Address - Country:US
Practice Address - Phone:970-445-2489
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-10-22
Last Update Date:2023-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health