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General NPI Number Information
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NPI Number | 1780479873
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Entity Type | Organization
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Legal Business Name | MOUNTAIN VIEW WELLNESS, LLC
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Dates
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Enumeration Date | 04/10/2025
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Last Update Date | 04/10/2025
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Provider Practice Location Address
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Address Line | 45 E LOUCKS ST STE 18
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City | SHERIDAN
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State | WY
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Zip | 82801-6328
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Country | US
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Telephone | 307-575-1430
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Fax | 307-263-7519
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Provider Business Mailing Address
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Address Line | 374 W ALGER ST APT C
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City | SHERIDAN
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State | WY
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Zip | 82801-3830
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Country | US
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Telephone | 307-575-1430
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Fax | 307-263-7519
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Authorized Official
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Title or Position | OWNER/ LPC
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Name | JASZMYNE ASHLEEANN BEVERLY
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Credential | MAE, LPC
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Telephone | 307-575-1430
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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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 | 261QM0855X
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Taxonomy Name | Adolescent and Children Mental Health Clinic/Center
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License Number |
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License Number State |
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