Bitterroot Family Therapy Inc.
Organization Active NPI Mental Health Counselor · Fort Bragg, CA
NPI 1003401910 · NPPES record last updated Jun 20, 2022
Key facts
- NPI
- 1003401910
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Mental Health Counselor 101YM0800X
- Legal business name
- BITTERROOT FAMILY THERAPY INC.
- Practice address
- 347 Cypress St Ste a
Fort Bragg, CA 95437-5458 - Phone
- (707) 962-3161
- Fax
- (707) 937-1876
- NPI assigned
- Mar 2, 2021
- Organization subpart
- No
Authorized official
- Name
- Lisa Larimer Burtis, LMFT
- Title
- Chief Executive Officer
- Phone
- (707) 962-3161
Practitioners 3
-
Peter K Burtis, LMFT
-
Lisa Larimer Burtis, LMFT
-
Scott Matthew Taubold, PH.D.
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in CA
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20240125000609 | CA | Part B Supplier - Clinic/Group Practice | 2163875287 |
Receives reassigned benefits from 2 practitioners Practice locations: Fort Bragg, CA |
National Provider Directory
Locations
347 Cypress St
Ste A
Fort Bragg, CA 95437
Phone (707) 962-3161
327 E Redwood Ave
Ste B
Fort Bragg, CA 95437
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Mental Health Counselor |
101YM0800X | Yes | ||
| Mental Health Clinic/Center (Including Community Mental Health Center) | 261QM0801X |
Addresses
Primary practice location
347 Cypress St Ste a
Fort Bragg, CA 95437-5458
Mailing address
PO Box 653
Mendocino, CA 95460-0653
Phone (707) 962-3161
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1952445454 | Medicaid | CA |
Other providers in Fort Bragg, CA
- Jack Linn Bellah
- Logan Christopher Bengston
- Zoe D Berna
- Jeff Bertheola
- Janet Lynn Biasca
- Rena Blauner
- Colleen Boggs
- Lynne Barbara Bornheim
- Brandon Lebeck Dental Corp
- Jenna Rose Breton
All providers in Fort Bragg, CA · Mental Health Counselor in California
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jun 20, 2022. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.