Healthcare Provider Details

I. General information

NPI: 1043079015
Provider Name (Legal Business Name): MOUNTAIN VIEW MENTAL HEALTH AND PRIMARY CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/13/2024
Last Update Date: 03/20/2026
Certification Date: 03/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1055 RUTH ST STE 1A
PRESCOTT AZ
86301-1740
US

IV. Provider business mailing address

1055 RUTH ST STE 1A
PRESCOTT AZ
86301-1740
US

V. Phone/Fax

Practice location:
  • Phone: 928-515-2443
  • Fax: 928-227-2496
Mailing address:
  • Phone: 928-515-2443
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code246RM2200X
TaxonomyMedical Laboratory Technician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: CHERI LEE LEDSOME
Title or Position: OWNER
Credential: NP
Phone: 928-515-2443