Provider Demographics
NPI:1720850043
Name:MOUNTAIN MEADOW COUNSELING SERVICES PLLC
Entity type:Organization
Organization Name:MOUNTAIN MEADOW COUNSELING SERVICES PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER/LCSW
Authorized Official - Prefix:
Authorized Official - First Name:JACQUELINE
Authorized Official - Middle Name:
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:775-386-2333
Mailing Address - Street 1:59 DAMONTE RANCH PKWY
Mailing Address - Street 2:STE. B, #228
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89521
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:10794 STONE HOLLOW DR
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89521-6282
Practice Address - Country:US
Practice Address - Phone:775-386-2333
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-10-30
Last Update Date:2023-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)