Provider Demographics
NPI:1407481724
Name:MOUNT MANSFIELD COUNSELING SERVICES LLC
Entity type:Organization
Organization Name:MOUNT MANSFIELD COUNSELING SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICSW
Authorized Official - Prefix:
Authorized Official - First Name:STACY
Authorized Official - Middle Name:M
Authorized Official - Last Name:BURNETT
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:802-858-5576
Mailing Address - Street 1:19 OLD FARM RD
Mailing Address - Street 2:
Mailing Address - City:JERICHO
Mailing Address - State:VT
Mailing Address - Zip Code:05465-2502
Mailing Address - Country:US
Mailing Address - Phone:802-598-9243
Mailing Address - Fax:
Practice Address - Street 1:213 VERMONT ROUTE 15
Practice Address - Street 2:
Practice Address - City:JERICHO
Practice Address - State:VT
Practice Address - Zip Code:05465-9639
Practice Address - Country:US
Practice Address - Phone:802-598-9243
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-03-06
Last Update Date:2020-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health