Provider Demographics
NPI:1861366270
Name:ZION MOUNTAINS
Entity type:Organization
Organization Name:ZION MOUNTAINS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JASEN
Authorized Official - Middle Name:J
Authorized Official - Last Name:LIVERMORE
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:307-355-9266
Mailing Address - Street 1:956 12TH ST
Mailing Address - Street 2:
Mailing Address - City:CODY
Mailing Address - State:WY
Mailing Address - Zip Code:82414-3602
Mailing Address - Country:US
Mailing Address - Phone:307-355-9266
Mailing Address - Fax:
Practice Address - Street 1:956 12TH ST
Practice Address - Street 2:
Practice Address - City:CODY
Practice Address - State:WY
Practice Address - Zip Code:82414-3602
Practice Address - Country:US
Practice Address - Phone:307-355-9266
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-09-30
Last Update Date:2025-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty