Provider Demographics
NPI:1134586274
Name:MOUNTAIN CREST COUNSELING SERVICES, LLC
Entity type:Organization
Organization Name:MOUNTAIN CREST COUNSELING SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/COUNSELOR
Authorized Official - Prefix:
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:JOEL
Authorized Official - Last Name:TAYLOR
Authorized Official - Suffix:
Authorized Official - Credentials:MA, CAMSII
Authorized Official - Phone:503-798-3271
Mailing Address - Street 1:8305 SE MONTEREY AVE
Mailing Address - Street 2:SUITE 111
Mailing Address - City:HAPPY VALLEY
Mailing Address - State:OR
Mailing Address - Zip Code:97086
Mailing Address - Country:US
Mailing Address - Phone:503-798-3271
Mailing Address - Fax:
Practice Address - Street 1:8305 SE MONTEREY AVE
Practice Address - Street 2:SUITE 111
Practice Address - City:HAPPY VALLEY
Practice Address - State:OR
Practice Address - Zip Code:97086
Practice Address - Country:US
Practice Address - Phone:503-798-3271
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-01-20
Last Update Date:2021-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health