=====================================================
General NPI Number Information
=====================================================
NPI Number | 1801564802
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MOUNT NORTH, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/03/2021
-----------------------------------------------------
Last Update Date | 09/22/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 258 MAIN ST
-----------------------------------------------------
City | GRAMPIAN
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 16838-9337
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 833-668-6861
-----------------------------------------------------
Fax | 805-232-7770
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 106
-----------------------------------------------------
City | GRAMPIAN
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 16838-0106
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 833-668-6861
-----------------------------------------------------
Fax | 805-232-7770
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | SHANNON BEAVER
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 833-668-6861
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YP2500X
-----------------------------------------------------
Taxonomy Name | Professional Counselor
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------