Provider Demographics
NPI:1588378442
Name:MOUNTAIN MENTAL HEALTH LLC
Entity type:Organization
Organization Name:MOUNTAIN MENTAL HEALTH LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PMHNP
Authorized Official - Prefix:
Authorized Official - First Name:SHANE
Authorized Official - Middle Name:EMERON
Authorized Official - Last Name:CARTER
Authorized Official - Suffix:
Authorized Official - Credentials:PMHNP
Authorized Official - Phone:801-918-1786
Mailing Address - Street 1:4516 S 700 E STE 370
Mailing Address - Street 2:
Mailing Address - City:MURRAY
Mailing Address - State:UT
Mailing Address - Zip Code:84107-8317
Mailing Address - Country:US
Mailing Address - Phone:801-918-1786
Mailing Address - Fax:385-200-0285
Practice Address - Street 1:4516 S 700 E STE 370
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84107-8317
Practice Address - Country:US
Practice Address - Phone:801-918-1786
Practice Address - Fax:385-200-0285
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-01-05
Last Update Date:2023-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental HealthGroup - Multi-Specialty
No261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty