| Providence Mental Health Pllc | |
|
2246 Boot Hill Ct. Unit #4 Bozeman MT 59715 | |
| (406) 579-4984 | |
| Not Available |
| Full Name | Providence Mental Health Pllc |
|---|---|
| Speciality | Social Worker |
| Location | 2246 Boot Hill Ct. Unit #4, Bozeman, Montana |
| Authorized Official Name and Position | Kevin Patrick Maxwell (CLINICAL DIRECTOR, CLINICIAN) |
| Authorized Official Contact | 4065794984 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Providence Mental Health Pllc 2246 Boot Hill Ct. Unit #4 Bozeman MT 59715 Ph: (406) 579-4984 | Providence Mental Health Pllc 2246 Boot Hill Ct. Unit #4 Bozeman MT 59715 Ph: (406) 579-4984 |
| NPI Number | 1194291609 |
|---|---|
| Provider Enumeration Date | 10/23/2018 |
| Last Update Date | 10/23/2018 |
| Medicare PECOS PAC ID | 8921341157 |
|---|---|
| Medicare Enrollment ID | O20190509002756 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1194291609 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | (* (Not Available)) | Primary |
| Provider Name | Shelli L Griffith |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1790102283 PECOS PAC ID: 0840423653 Enrollment ID: I20140501001666 |
| Provider Name | Lacey Staszcuk |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1841732823 PECOS PAC ID: 5496030025 Enrollment ID: I20170322002821 |
| Provider Name | Larisa L Hammond |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1053801894 PECOS PAC ID: 7719239227 Enrollment ID: I20181011001130 |
| Provider Name | Jentry Ann Wheaton |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1164920088 PECOS PAC ID: 7416380761 Enrollment ID: I20191127001839 |
| Provider Name | Alexis R Sandoval |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1245523836 PECOS PAC ID: 6800221276 Enrollment ID: I20200113000330 |
| Provider Name | Clayleen I Pipinich |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1992340988 PECOS PAC ID: 8123438231 Enrollment ID: I20201030002106 |
| Provider Name | Brandy Leigh Colvin |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1730796699 PECOS PAC ID: 8224438718 Enrollment ID: I20210621003378 |
| Provider Name | Rebecca Sulages |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1871166751 PECOS PAC ID: 5597160283 Enrollment ID: I20210818001939 |
| Provider Name | Kathleen Neuman |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1871094755 PECOS PAC ID: 1658776893 Enrollment ID: I20210825003634 |
| Provider Name | Asta Reindl |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1033643713 PECOS PAC ID: 3476942541 Enrollment ID: I20211110002442 |
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