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Mountain Mental Health LLC

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Company Details

Name: Mountain Mental Health LLC
Jurisdiction: Idaho
Legal type: Limited Liability Company (D)
Status: Active-Existing
Date of registration: 27 Apr 2023 (2 years ago)
Financial Date End: 30 Apr 2025
Entity Number: 5216462
Place of Formation: IDAHO
File Number: 877102
ZIP code: 83455
County: Teton County
Principal Address: 78 N MAIN ST VICTOR, ID 83455
Mailing Address: 183 ABBY LOOP UNIT 15 VICTOR, ID 83455-1309

Agent

Name Role Address
CHARLOTTE DIPRISCO Agent 183 ABBY LOOP UNIT 15, VICTOR, ID 83455

Manager

Name Role Address Appointed On
Charlotte Vincent Manager 89 N. MAIN STREET, DRIGGS, ID 83422 2024-04-04

National Provider Identifier

NPI Number:
1124716261
Certification Date:
2023-04-26

Authorized Person:

Name:
CHARLOTTE P. DIPRISCO
Role:
THERAPIST
Phone:

Taxonomy:

Selected Taxonomy:
261QM0801X - Mental Health Clinic/Center (Including Community Mental Health Center)
Is Primary:
Yes

Contacts:

Filing

Filing Name Filing Number Filing date
Annual Report 0005673436 2024-04-04
Initial Filing 0005216462 2023-04-27

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Date of last update: 26 Mar 2025

Sources: Idaho Secretary of State