Organization
MOUNTAIN PSYCHIATRIC, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. JENNIFER COLORADO (CREDENTIALING)
(832) 494-6448
Entity
Organization
Contact information
Practice address
5115 BERNARD DR, SUITE 105, ROANOKE, VA 24018-4357
(540) 728-1570
Mailing address
5115 BERNARD DR, SUITE 105, ROANOKE, VA 24018-4357
(540) 728-1570
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
—
—
Other
Enumeration date
03/13/2014
Last updated
03/19/2014
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