| Blue Mountain Behavioral Health Pllc | |
|
6711 Regents Blvd Ste B University Place WA 98466-5421 | |
| (253) 240-1964 | |
| Not Available |
| Full Name | Blue Mountain Behavioral Health Pllc |
|---|---|
| Speciality | Marriage & Family Therapist |
| Location | 6711 Regents Blvd Ste B, University Place, Washington |
| Authorized Official Name and Position | Laura M Ibarra (OWNER/PROVIDER) |
| Authorized Official Contact | 2532401964 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Blue Mountain Behavioral Health Pllc 6711 Regents Blvd Ste B University Place WA 98466-5421 Ph: (253) 240-1964 | Blue Mountain Behavioral Health Pllc 6711 Regents Blvd Ste B University Place WA 98466-5421 Ph: (253) 240-1964 |
| NPI Number | 1255046231 |
|---|---|
| Provider Enumeration Date | 01/13/2023 |
| Last Update Date | 09/16/2024 |
| Certification Date | 09/16/2024 |
| Medicare PECOS PAC ID | 3870964786 |
|---|---|
| Medicare Enrollment ID | O20241017003272 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1255046231 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YA0400X | Counselor - Addiction (substance Use Disorder) | (* (Not Available)) | Secondary |
| 106H00000X | Marriage & Family Therapist | (* (Not Available)) | Primary |
| Provider Name | Laura M Ibarra |
|---|---|
| Provider Type | Practitioner - Marriage And Family Therapist |
| Provider Identifiers | NPI Number: 1619133931 PECOS PAC ID: 6002287901 Enrollment ID: I20241017003383 |
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