Healthcare Provider Details

I. General information

NPI: 1275469595
Provider Name (Legal Business Name): MOUNTAIN MENTAL HEALTH PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/23/2026
Last Update Date: 06/23/2026
Certification Date: 06/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14205 SE 36TH ST STE 100
BELLEVUE WA
98006-1553
US

IV. Provider business mailing address

14205 SE 36TH ST STE 100
BELLEVUE WA
98006-1553
US

V. Phone/Fax

Practice location:
  • Phone: 425-657-8819
  • Fax: 507-607-8918
Mailing address:
  • Phone: 425-657-8819
  • Fax: 507-607-8918

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State

VIII. Authorized Official

Name: ILYSE ROSENBERG
Title or Position: DR
Credential: DO
Phone: 425-657-8819