Provider Demographics
NPI:1457070039
Name:MOUNTAIN AIR COUNSELING AND GRIEF THERAPY LLC
Entity Type:Organization
Organization Name:MOUNTAIN AIR COUNSELING AND GRIEF THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SHANNON
Authorized Official - Middle Name:
Authorized Official - Last Name:HARRIS
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:307-331-2862
Mailing Address - Street 1:5095 GEORGETOWN DR
Mailing Address - Street 2:
Mailing Address - City:LOVELAND
Mailing Address - State:CO
Mailing Address - Zip Code:80538-6808
Mailing Address - Country:US
Mailing Address - Phone:307-331-2862
Mailing Address - Fax:
Practice Address - Street 1:8010 S COUNTY ROAD 5 UNIT 103
Practice Address - Street 2:
Practice Address - City:WINDSOR
Practice Address - State:CO
Practice Address - Zip Code:80528-9004
Practice Address - Country:US
Practice Address - Phone:307-331-2862
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-08-25
Last Update Date:2022-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Single Specialty