Mountain Therapy Collaborative

LBN: Mountain Therapy Collaborative
Mountain Therapy Collaborative is an health care organization with primary practice located at 870 Emerald Bay Rd Ste 303 , South Lake Tahoe CA 96150-9400. The organization recently has 3 registered licenses in different health care specialties including Behavioral Health & Social Service Providers / Group Psychotherapy, Behavioral Health & Social Service Providers / Clinical, Respiratory, Developmental, Rehabilitative and Restorative Service Providers / Occupational Therapy Assistant. Behavioral Health & Social Service Providers / Group Psychotherapy is the primary health care specialty. Mountain Therapy Collaborative can be contacted via phone (415) 806-0275, or through Wong, Matthew via phone (415) 806-0275.

Contact Information

Primary practice address
870 Emerald Bay Rd Ste 303 South Lake Tahoe CA 96150-9400
Phone: (415) 806-0275
Fax: (530) 600-0063
Website:
Map and Directions
Authorized official contact:
Name: Wong, Matthew M.A., PSY.D.
Phone: (415) 806-0275

Health care specialties

SpecialtyCodeLicense #State
Behavioral Health & Social Service Providers / Group Psychotherapy 103TP2701X
Behavioral Health & Social Service Providers / Clinical 1041C0700X
Respiratory, Developmental, Rehabilitative and Restorative Service Providers / Occupational Therapy Assistant 224Z00000X

Profile Details

NPI number 1053825505
LBN Legal business name Mountain Therapy Collaborative
DBA Doing business as
Authorized official Wong, Matthew M.A., PSY.D.
Entity Organization
Organization subpart 1 No
Enumeration date Nov 20th, 2017
Last updated Nov 20th, 2017 - about 8 years ago

1 Some organizations, which are providing health care services, may consist of units or departments that provide different types of health care services or have several separate physical locations, where health care service is provided. These units, departments or physical locations are not themselves legal entities. However, each of them is part of the organization, which is a legal entity. The organization may decide whether its subparts, if it has any, should have their own NPI numbers. In case a subpart conducts any HIPAA standard transactions by itself, without its parent's involvement, it must have its own NPI number.

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Identifiers

StateTypeNumberIssuer
All States NPI 1053825505 NPPES
California MEDICAID 1598157117
California MEDICAID 1619169653

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