MEDICARE: MOUNTAIN RISE COUNSELING, 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

General Provider Information

NPI Number	:	1538982160
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MOUNTAIN RISE COUNSELING, LLC

Provider Business Mailing Address
First Line	:	315 CABLE PL
Second Line	:
City	:	FRONT ROYAL
State	:	VA
Zip	:	22630-3019
Country	:	US
Telephone Number	:	240-643-8756
Fax Number	:

Provider Business Practice Location Address
First Line	:	315 CABLE PL
Second Line	:
City	:	FRONT ROYAL
State	:	VA
Zip	:	22630-3019
Country	:	US
Telephone Number	:	571-303-9459
Fax Number	:

Authorized Official
Title or Position	:	PRACTICE OWNER/THERAPIST
Name	:	SILVIA PORTILLO
Credential	:	LPC
Telephone Number	:	571-303-9459

Provider Enumeration Date	:	11/04/2024
Last Update Date	:	11/04/2024

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