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General NPI Number Information
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NPI Number | 1265967095
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Entity Type | Organization
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Legal Business Name | BLUE MOUNTAIN COUNSELING,LLC
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Dates
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Enumeration Date | 04/30/2017
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Last Update Date | 04/30/2017
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Provider Practice Location Address
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Address Line | 518 28 RD B102
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City | GRAND JUNCTION
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State | CO
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Zip | 81501-6556
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Country | US
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Telephone | 970-361-2287
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Fax |
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Provider Business Mailing Address
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Address Line | 518 28 RD B102
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City | GRAND JUNCTION
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State | CO
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Zip | 81501-6556
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Country | US
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Telephone | 970-361-2287
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | VIRGINIA A. RUSY
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Credential | LPC, RD
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Telephone | 970-361-2287
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | LPC 0013044
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License Number State | CO
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