Healthcare Provider Details

I. General information

NPI: 1003490988
Provider Name (Legal Business Name): MOUNTAIN VISTA PSYCHOLOGY, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/07/2021
Last Update Date: 07/26/2023
Certification Date: 07/26/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7325 S PIERCE ST # 203E-103
LITTLETON CO
80128-4553
US

IV. Provider business mailing address

88 INVERNESS CIR E UNIT E103
ENGLEWOOD CO
80112-5511
US

V. Phone/Fax

Practice location:
  • Phone: 720-583-9332
  • Fax:
Mailing address:
  • Phone: 720-583-9332
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State

VIII. Authorized Official

Name: MRS. TARA MCCONNELL
Title or Position: OFFICE MANAGER
Credential:
Phone: 720-583-9332