Provider Demographics
NPI:1447018544
Name:MYSTIC MOUNTAIN MIDWIFERY, LLC.
Entity type:Organization
Organization Name:MYSTIC MOUNTAIN MIDWIFERY, LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MIDWIFE/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ALEXANDRA
Authorized Official - Middle Name:
Authorized Official - Last Name:SENECHAL
Authorized Official - Suffix:
Authorized Official - Credentials:LM, CPM
Authorized Official - Phone:253-693-0275
Mailing Address - Street 1:30902 12TH AVENUE CT E
Mailing Address - Street 2:
Mailing Address - City:ROY
Mailing Address - State:WA
Mailing Address - Zip Code:98580-8806
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:207 CENTER STREET E
Practice Address - Street 2:
Practice Address - City:EATONVILLE
Practice Address - State:WA
Practice Address - Zip Code:98328
Practice Address - Country:US
Practice Address - Phone:253-693-0275
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-03-12
Last Update Date:2024-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes176B00000XOther Service ProvidersMidwifeGroup - Single Specialty