Provider Demographics
NPI:1295954741
Name:VICTORY MOUNTAIN, INC.
Entity type:Organization
Organization Name:VICTORY MOUNTAIN, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:
Authorized Official - Last Name:SKINNER
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:573-546-7592
Mailing Address - Street 1:HC 69 BOX 1455
Mailing Address - Street 2:
Mailing Address - City:IRONTON
Mailing Address - State:MO
Mailing Address - Zip Code:63650-9606
Mailing Address - Country:US
Mailing Address - Phone:573-546-7592
Mailing Address - Fax:573-546-0125
Practice Address - Street 1:HC 69 BOX 1455
Practice Address - Street 2:
Practice Address - City:IRONTON
Practice Address - State:MO
Practice Address - Zip Code:63650-9606
Practice Address - Country:US
Practice Address - Phone:573-546-7592
Practice Address - Fax:573-546-0125
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-24
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO322D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes322D00000XResidential Treatment FacilitiesResidential Treatment Facility, Emotionally Disturbed Children