Provider Demographics
NPI:1902132061
Name:MOUNTAIN VIEW BEHAVIORAL HEALTH, PLLC
Entity Type:Organization
Organization Name:MOUNTAIN VIEW BEHAVIORAL HEALTH, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER/CLINICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:EVELYN
Authorized Official - Middle Name:CARY KRUEGER
Authorized Official - Last Name:HARRIOTT
Authorized Official - Suffix:
Authorized Official - Credentials:EDD
Authorized Official - Phone:603-532-7185
Mailing Address - Street 1:13 HARKNESS RD
Mailing Address - Street 2:
Mailing Address - City:JAFFREY
Mailing Address - State:NH
Mailing Address - Zip Code:03452-5420
Mailing Address - Country:US
Mailing Address - Phone:603-532-7185
Mailing Address - Fax:
Practice Address - Street 1:9 BLAKE ST
Practice Address - Street 2:SUITE #4
Practice Address - City:JAFFREY
Practice Address - State:NH
Practice Address - Zip Code:03452-6577
Practice Address - Country:US
Practice Address - Phone:603-371-7305
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-26
Last Update Date:2011-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH1147103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty