Provider Demographics
NPI:1174339865
Name:EAGLE VALLEY MENTAL HEALTH
Entity type:Organization
Organization Name:EAGLE VALLEY MENTAL HEALTH
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:SENIOR DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:CASEY
Authorized Official - Middle Name:L
Authorized Official - Last Name:ANGEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:970-306-3773
Mailing Address - Street 1:PO BOX 1529
Mailing Address - Street 2:
Mailing Address - City:VAIL
Mailing Address - State:CO
Mailing Address - Zip Code:81658-1529
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:410 MCGREGOR DR
Practice Address - Street 2:
Practice Address - City:GYPSUM
Practice Address - State:CO
Practice Address - Zip Code:81637
Practice Address - Country:US
Practice Address - Phone:970-945-2840
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-12-06
Last Update Date:2025-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251S00000XAgenciesCommunity/Behavioral Health
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)