Healthcare Provider Details

I. General information

NPI: 1821869918
Provider Name (Legal Business Name): MOUNTAIN VIEW PSYCHIATRY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/09/2024
Last Update Date: 01/09/2024
Certification Date: 01/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

115 W MAIN ST
HANCOCK MD
21750-1416
US

IV. Provider business mailing address

PO BOX 122
HANCOCK MD
21750-0122
US

V. Phone/Fax

Practice location:
  • Phone: 240-738-0954
  • Fax: 301-238-7386
Mailing address:
  • Phone: 240-738-0954
  • Fax: 301-238-7386

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: AMANDA BROOKE BAULER
Title or Position: OWNER
Credential: PMHNP
Phone: 240-738-0954