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MOUNTAIN THERAPY COLLABORATIVE NPI 1053825505


NPI Information

NPI: 1053825505
Provider Name: MOUNTAIN THERAPY COLLABORATIVE
Classification: Psychologist - 103TP2701X
Entity Type: Organization

Specialization: Group Psychotherapy

Address:
870 EMERALD BAY RD STE 303
SOUTH LAKE TAHOE, CA
ZIP 96150
Phone: (415) 806-0275
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MOUNTAIN THERAPY COLLABORATIVE is a group psychotherapy psychologist in South Lake Tahoe, CA. The provider is a psychologist who specializes in group psychology and group psychotherapy that is an evidenced-based specialty that prepares group leaders to identify and capitalize on developmental and healing possibilities embedded in the interpersonal/intrapersonal functioning of individual group members as well as collectively for the group. Emphasis is placed on the use of group dynamics to assist and treat individual group members. The specialty is applicable to all age groups, children, adolescents, adults and older adults, for a wide variety of conditions and concerns, and in numerous and diverse settings. MOUNTAIN THERAPY COLLABORATIVE NPI is 1053825505. The provider is registered as an organization entity type and is a multi-specialty group.

The provider's business location address is:

870 EMERALD BAY RD STE 303
SOUTH LAKE TAHOE, CA
ZIP 96150-400
Phone: (415) 806-0275
Fax: (530) 600-0063

The provider's authorized official is Matthew Wong .
The authorized official title is Owner and has the following contact phone number (415) 806-0275.

The enumeration date for this NPI number is 11/20/2017 and was last updated on 11/20/2017.


Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1103TP2701XPsychologistGroup PsychotherapyYes
21041C0700XSocial WorkerClinicalNo
3224Z00000XOccupational Therapy AssistantNo

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No. Other Provider Identifier Other Provider Identifier Type Other Provider Identifier State Other Provider Identifier Issuer
11598157117MEDICAIDCALIFORNIA
21619169653MEDICAIDNORTH CAROLINA

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 5/5/2024

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