Healthcare Provider Details

I. General information

NPI: 1982896122
Provider Name (Legal Business Name): MOUNTAINEER MUSIC THERAPY SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/13/2007
Last Update Date: 08/13/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

208 RIDGECREST DRIVE
ELIZABETHTON TN
37643-3026
US

IV. Provider business mailing address

208 RIDGECREST DRIVE
ELIZABETHTON TN
37643-3026
US

V. Phone/Fax

Practice location:
  • Phone: 423-547-3761
  • Fax:
Mailing address:
  • Phone: 423-547-3761
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225A00000X
TaxonomyMusic Therapist
License Number
License Number State

VIII. Authorized Official

Name: MRS. NANCY MARIE NORNHOLD
Title or Position: CEO PRESIDENT
Credential: MT BC
Phone: 423-547-3761