Healthcare Provider Details

I. General information

NPI: 1376359539
Provider Name (Legal Business Name): MOUNTAIN ELEMENTARY SCHOOL DISTRICT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/03/2024
Last Update Date: 12/03/2024
Certification Date: 12/03/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3042 OLD SAN JOSE RD
SOQUEL CA
95073-9453
US

IV. Provider business mailing address

3042 OLD SAN JOSE RD
SOQUEL CA
95073-9453
US

V. Phone/Fax

Practice location:
  • Phone: 831-887-8236
  • Fax: 831-464-7200
Mailing address:
  • Phone: 831-887-8236
  • Fax: 831-464-7200

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: MEGAN TRESHAM
Title or Position: SUPERINTENDENT
Credential:
Phone: 831-475-6812