Healthcare Provider Details

I. General information

NPI: 1649186057
Provider Name (Legal Business Name): BLUE MOUNTAIN MENTAL HEALTH, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/24/2026
Last Update Date: 08/24/2026
Certification Date: 08/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2500 BOBBY FOSTER RD SE UNIT F212
ALBUQUERQUE NM
87106-9014
US

IV. Provider business mailing address

2500 BOBBY FOSTER RD SE UNIT F212
ALBUQUERQUE NM
87106-9014
US

V. Phone/Fax

Practice location:
  • Phone: 703-965-1900
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: CAMILLE WHITE
Title or Position: OWNER
Credential: LCSW
Phone: 703-965-1900