MEDICARE: MOUNTAIN MINDSET LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YP2500X	Professional Counselor

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1407321615
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MOUNTAIN MINDSET LLC

Provider Business Mailing Address
First Line	:	7686 CINCINNATI DAYTON RD STE A-4
Second Line	:
City	:	WEST CHESTER
State	:	OH
Zip	:	45069-1539
Country	:	US
Telephone Number	:	513-601-8289
Fax Number	:

Provider Business Practice Location Address
First Line	:	7686 CINCINNATI DAYTON RD STE A-4
Second Line	:
City	:	WEST CHESTER
State	:	OH
Zip	:	45069-1539
Country	:	US
Telephone Number	:	513-601-8289
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	ANN KENDIG
Credential	:	LPCC LICDC
Telephone Number	:	513-601-8289

Provider Enumeration Date	:	10/04/2018
Last Update Date	:	10/04/2018

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Directions to “MOUNTAIN MINDSET LLC ” Practice Location

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