Provider Demographics
NPI:1205466273
Name:MT NEBO MENTAL HEALTH
Entity type:Organization
Organization Name:MT NEBO MENTAL HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LUCINDA
Authorized Official - Middle Name:
Authorized Official - Last Name:BERGE
Authorized Official - Suffix:
Authorized Official - Credentials:LMHC
Authorized Official - Phone:801-403-4959
Mailing Address - Street 1:1108 W 1290 S
Mailing Address - Street 2:
Mailing Address - City:PAYSON
Mailing Address - State:UT
Mailing Address - Zip Code:84651-5770
Mailing Address - Country:US
Mailing Address - Phone:801-403-4959
Mailing Address - Fax:
Practice Address - Street 1:1172 E 100 N STE 10
Practice Address - Street 2:
Practice Address - City:PAYSON
Practice Address - State:UT
Practice Address - Zip Code:84651-1691
Practice Address - Country:US
Practice Address - Phone:801-403-4959
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-01-18
Last Update Date:2020-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty