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General NPI Number Information
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NPI Number | 1033805015
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Entity Type | Organization
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Legal Business Name | MOUNTAIN HIGH RECOVERY CENTER
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Dates
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Enumeration Date | 04/13/2023
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Last Update Date | 04/13/2023
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Provider Practice Location Address
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Address Line | 2949 LAKE TAHOE BLVD SUITE B7
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City | SOUTH LAKE TAHOE
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State | CA
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Zip | 96150
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Country | US
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Telephone | 530-600-6505
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Fax |
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Provider Business Mailing Address
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Address Line | 2949 LAKE TAHOE BLVD SUITE B7
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City | SOUTH LAKE TAHOE
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State | CA
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Zip | 96150
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Country | US
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Telephone | 530-600-6505
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Fax |
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Authorized Official
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Title or Position | ADMINISTRATIVE ASSISTANT
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Name | KIM HEWETT
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Credential |
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Telephone | 918-207-9519
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number |
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License Number State |
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