Provider Demographics
NPI:1336957901
Name:SUNFLOWER MOUNTAIN MENTAL HEALTH, LLC
Entity type:Organization
Organization Name:SUNFLOWER MOUNTAIN MENTAL HEALTH, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:
Authorized Official - Last Name:BLUBAUGH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:719-679-5022
Mailing Address - Street 1:805 EAGLERIDGE BLVD STE 140
Mailing Address - Street 2:
Mailing Address - City:PUEBLO
Mailing Address - State:CO
Mailing Address - Zip Code:81008-2354
Mailing Address - Country:US
Mailing Address - Phone:719-679-5022
Mailing Address - Fax:719-888-1673
Practice Address - Street 1:805 EAGLERIDGE BLVD STE 140
Practice Address - Street 2:
Practice Address - City:PUEBLO
Practice Address - State:CO
Practice Address - Zip Code:81008-2354
Practice Address - Country:US
Practice Address - Phone:719-679-5022
Practice Address - Fax:719-888-1673
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-12-27
Last Update Date:2024-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty