Provider Demographics
NPI:1902626153
Name:MOUNTAIN RIDGE BEHAVIORAL HEALTH CENTER
Entity type:Organization
Organization Name:MOUNTAIN RIDGE BEHAVIORAL HEALTH CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SUMMER
Authorized Official - Middle Name:
Authorized Official - Last Name:SIMMONS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:385-482-3688
Mailing Address - Street 1:704 S 1600 W STE 104
Mailing Address - Street 2:
Mailing Address - City:MAPLETON
Mailing Address - State:UT
Mailing Address - Zip Code:84664-4462
Mailing Address - Country:US
Mailing Address - Phone:801-491-6394
Mailing Address - Fax:801-491-6613
Practice Address - Street 1:704 S 1600 W STE 104
Practice Address - Street 2:
Practice Address - City:MAPLETON
Practice Address - State:UT
Practice Address - Zip Code:84664-4462
Practice Address - Country:US
Practice Address - Phone:801-491-6394
Practice Address - Fax:801-491-6613
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-10-14
Last Update Date:2024-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty