Provider Demographics
NPI:1154386555
Name:MOUNTAIN LAKE ASSOCIATES,PC
Entity type:Organization
Organization Name:MOUNTAIN LAKE ASSOCIATES,PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:BEVERLY
Authorized Official - Middle Name:A
Authorized Official - Last Name:HAWPE
Authorized Official - Suffix:
Authorized Official - Credentials:LPC, LAC
Authorized Official - Phone:719-686-8560
Mailing Address - Street 1:333 W. LAKE ST
Mailing Address - Street 2:SUITE 2E
Mailing Address - City:WOODLAND PARK
Mailing Address - State:CO
Mailing Address - Zip Code:80863
Mailing Address - Country:US
Mailing Address - Phone:719-686-8560
Mailing Address - Fax:719-227-7745
Practice Address - Street 1:724 N TEJON ST
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80903-1012
Practice Address - Country:US
Practice Address - Phone:719-686-8560
Practice Address - Fax:719-227-7745
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO242101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty