Provider Demographics
NPI:1265967095
Name:BLUE MOUNTAIN COUNSELING,LLC
Entity type:Organization
Organization Name:BLUE MOUNTAIN COUNSELING,LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:VIRGINIA
Authorized Official - Middle Name:A
Authorized Official - Last Name:RUSY
Authorized Official - Suffix:
Authorized Official - Credentials:LPC, RD
Authorized Official - Phone:970-361-2287
Mailing Address - Street 1:518 28 RD
Mailing Address - Street 2:B102
Mailing Address - City:GRAND JUNCTION
Mailing Address - State:CO
Mailing Address - Zip Code:81501-6556
Mailing Address - Country:US
Mailing Address - Phone:970-361-2287
Mailing Address - Fax:
Practice Address - Street 1:518 28 RD
Practice Address - Street 2:B102
Practice Address - City:GRAND JUNCTION
Practice Address - State:CO
Practice Address - Zip Code:81501-6556
Practice Address - Country:US
Practice Address - Phone:970-361-2287
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-04-30
Last Update Date:2017-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COLPC 0013044101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty