Healthcare Provider Details

I. General information

NPI: 1578132429
Provider Name (Legal Business Name): MOUNTAIN SPRINGS COUNSELING CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/23/2021
Last Update Date: 07/09/2024
Certification Date: 07/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1075 S CHECK ST STE 110
WASILLA AK
99654-8067
US

IV. Provider business mailing address

1075 S CHECK ST STE 110
WASILLA AK
99654-8067
US

V. Phone/Fax

Practice location:
  • Phone: 907-931-6928
  • Fax: 907-931-7138
Mailing address:
  • Phone: 907-931-6928
  • Fax: 907-931-7138

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: BETH JOHNSON
Title or Position: COUNSELOR/OWNER
Credential: MA, LPC, RPT
Phone: 907-931-6928