Healthcare Provider Details

I. General information

NPI: 1497478275
Provider Name (Legal Business Name): VISTA CHARTER SCHOOL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/26/2022
Last Update Date: 12/08/2022
Certification Date: 12/08/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1810 SAINT MARYS DR
MONTROSE CO
81401-5011
US

IV. Provider business mailing address

1810 SAINT MARYS DR
MONTROSE CO
81401-5011
US

V. Phone/Fax

Practice location:
  • Phone: 970-249-4470
  • Fax:
Mailing address:
  • Phone: 970-249-4470
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QS1000X
TaxonomyStudent Health Clinic/Center
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code251300000X
TaxonomyLocal Education Agency (LEA)
License Number
License Number StateNULL

VIII. Authorized Official

Name: ALISON HARRIS
Title or Position: MENTAL HEALTH COORDINATOR
Credential: MA,LPC, ACS
Phone: 970-249-4470