Provider Demographics
NPI:1750086799
Name:CRESTVIEW MENTAL HEALTH
Entity type:Organization
Organization Name:CRESTVIEW MENTAL HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BRANDON
Authorized Official - Middle Name:
Authorized Official - Last Name:GOLDER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:719-717-7113
Mailing Address - Street 1:2598 LACY HOLT RD
Mailing Address - Street 2:
Mailing Address - City:GRAHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27253-9472
Mailing Address - Country:US
Mailing Address - Phone:719-717-7113
Mailing Address - Fax:
Practice Address - Street 1:150 PROSPECT AVE STE 104
Practice Address - Street 2:
Practice Address - City:FRANKLIN
Practice Address - State:PA
Practice Address - Zip Code:16323-2554
Practice Address - Country:US
Practice Address - Phone:719-717-7113
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-03-31
Last Update Date:2023-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health