Provider Demographics
NPI:1043079015
Name:MOUNTAIN VIEW MENTAL HEALTH AND PRIMARY CARE
Entity type:Organization
Organization Name:MOUNTAIN VIEW MENTAL HEALTH AND PRIMARY CARE
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CHERI
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:LEDSOME
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:928-515-2443
Mailing Address - Street 1:1055 RUTH ST STE 1
Mailing Address - Street 2:
Mailing Address - City:PRESCOTT
Mailing Address - State:AZ
Mailing Address - Zip Code:86301-1740
Mailing Address - Country:US
Mailing Address - Phone:602-697-9358
Mailing Address - Fax:
Practice Address - Street 1:1055 RUTH ST STE 1
Practice Address - Street 2:
Practice Address - City:PRESCOTT
Practice Address - State:AZ
Practice Address - Zip Code:86301-1740
Practice Address - Country:US
Practice Address - Phone:928-515-2443
Practice Address - Fax:928-227-2496
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-03-13
Last Update Date:2024-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty