| Muddy Road Counseling Llc | |
|
100 E State St Ste 201 Montpelier VT 05602-3112 | |
| (802) 371-9727 | |
| Not Available |
| Full Name | Muddy Road Counseling Llc |
|---|---|
| Speciality | Clinic/Center |
| Location | 100 E State St Ste 201, Montpelier, Vermont |
| Authorized Official Name and Position | Amanda Long (OWNER) |
| Authorized Official Contact | 8023719727 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Muddy Road Counseling Llc 100 E State St Ste 201 Montpelier VT 05602-3112 Ph: (802) 371-9727 | Muddy Road Counseling Llc 100 E State St Ste 201 Montpelier VT 05602-3112 Ph: (802) 371-9727 |
| NPI Number | 1053117226 |
|---|---|
| Provider Enumeration Date | 02/19/2025 |
| Last Update Date | 02/19/2025 |
| Certification Date | 02/19/2025 |
| Medicare PECOS PAC ID | 4486175999 |
|---|---|
| Medicare Enrollment ID | O20250312002229 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1053117226 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0801X | Clinic/center - Mental Health (including Community Mental Health Center) | (* (Not Available)) | Primary |
| Provider Name | Amanda Louise Long |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1881499101 PECOS PAC ID: 5395266803 Enrollment ID: I20250312002439 |
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