Healthcare Provider Details

I. General information

NPI: 1265074777
Provider Name (Legal Business Name): MOUNTAIN CREST COUNSELING, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/16/2019
Last Update Date: 08/11/2025
Certification Date: 08/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16921 HIGHWAY 4
JEMEZ SPRINGS NM
87025-9453
US

IV. Provider business mailing address

PO BOX 192
JEMEZ SPRINGS NM
87025-0192
US

V. Phone/Fax

Practice location:
  • Phone: 505-263-4184
  • Fax:
Mailing address:
  • Phone: 505-263-4184
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: MS. AMELIA A TRUJILLO
Title or Position: OWNER/CLINICAL THERAPIST
Credential: LMFT
Phone: 505-263-4184