Healthcare Provider Details

I. General information

NPI: 1346052479
Provider Name (Legal Business Name): MOUNTAIN MENTAL HEALTH LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/24/2025
Last Update Date: 07/21/2026
Certification Date: 07/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

221 MAIN ST # 4126
NASHUA NH
03060-2913
US

IV. Provider business mailing address

221 MAIN ST # 4126
NASHUA NH
03060-2913
US

V. Phone/Fax

Practice location:
  • Phone: 720-689-3550
  • Fax:
Mailing address:
  • Phone: 720-689-3550
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VIII. Authorized Official

Name: CHAD KRUMPHOLZ
Title or Position: OWNER
Credential:
Phone: 720-689-3550