Basic Information
| Provider Information | |||||||||
| NPI: | 1245897206 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | GATEWAY MOUNTAIN CENTER, INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 10038 MEADOW WAY UNIT D | ||||||||
| Address2: | |||||||||
| City: | TRUCKEE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 961614974 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5304262110 | ||||||||
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| Practice Location | |||||||||
| Address1: | 10038 MEADOW WAY UNIT D | ||||||||
| Address2: | |||||||||
| City: | TRUCKEE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 961614974 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5304262110 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/24/2019 | ||||||||
| LastUpdateDate: | 07/10/2020 | ||||||||
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| AuthorizedOfficialLastName: | MAYFIELD | ||||||||
| AuthorizedOfficialFirstName: | PETER | ||||||||
| AuthorizedOfficialMiddleName: | CURRY | ||||||||
| AuthorizedOfficialTitleorPosition: | EXECUTIVE DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 5302056245 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 07/10/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | N | 193200000X MULTI-SPECIALTY GROUP | Behavioral Health & Social Service Providers | Counselor | Mental Health | 251S00000X | Y | Agencies | Community/Behavioral Health |
No ID Information.