Healthcare Provider Details

I. General information

NPI: 1780479873
Provider Name (Legal Business Name): MOUNTAIN VIEW WELLNESS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/10/2025
Last Update Date: 04/10/2025
Certification Date: 04/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

45 E LOUCKS ST STE 18
SHERIDAN WY
82801-6328
US

IV. Provider business mailing address

374 W ALGER ST APT C
SHERIDAN WY
82801-3830
US

V. Phone/Fax

Practice location:
  • Phone: 307-575-1430
  • Fax: 307-263-7519
Mailing address:
  • Phone: 307-575-1430
  • Fax: 307-263-7519

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: JASZMYNE ASHLEEANN BEVERLY
Title or Position: OWNER/ LPC
Credential: MAE, LPC
Phone: 307-575-1430