Provider Demographics
NPI:1982279808
Name:MOUNTAIN WELLNESS LLC
Entity Type:Organization
Organization Name:MOUNTAIN WELLNESS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ORGANIZER
Authorized Official - Prefix:MRS
Authorized Official - First Name:AMBER
Authorized Official - Middle Name:ELAINE
Authorized Official - Last Name:BARROWS
Authorized Official - Suffix:
Authorized Official - Credentials:MSW, LCSW
Authorized Official - Phone:541-530-8350
Mailing Address - Street 1:444 NE WINCHESTER ST
Mailing Address - Street 2:PMB 18A
Mailing Address - City:ROSEBURG
Mailing Address - State:OR
Mailing Address - Zip Code:97470-3256
Mailing Address - Country:US
Mailing Address - Phone:541-530-8350
Mailing Address - Fax:
Practice Address - Street 1:855 SE MOSHER AVE
Practice Address - Street 2:
Practice Address - City:ROSEBURG
Practice Address - State:OR
Practice Address - Zip Code:97470-3961
Practice Address - Country:US
Practice Address - Phone:541-530-8350
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-05-24
Last Update Date:2021-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)