Kelly Ewalt, Inc
Organization Active NPI Mental Health Clinic/Center (Including Community Mental Health Center) · Columbia Falls, MT
NPI 1114770591 · NPPES record last updated Apr 8, 2024
Key facts
- NPI
- 1114770591
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Mental Health Clinic/Center (Including Community Mental Health Center) 261QM0801X
- Legal business name
- KELLY EWALT, INC
- Practice address
- 305 1St Ave W
Columbia Falls, MT 59912-3625 - Phone
- (406) 249-9153
- Fax
- (406) 892-4606
- NPI assigned
- Apr 8, 2024
- Organization subpart
- No
Authorized official
- Name
- Kelly Ewalt
- Title
- Owner
- Phone
- (406) 249-9153
Practitioners 1
-
Kelly Anne Ewalt, LCPC
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in MT
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20241010002104 | MT | Part B Supplier - Clinic/Group Practice | 5698207041 |
Receives reassigned benefits from 1 practitioner Practice locations: Columbia Falls, MT |
National Provider Directory
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Mental Health Clinic/Center (Including Community Mental Health Center) | 261QM0801X | Yes |
Addresses
Primary practice location
305 1St Ave W
Columbia Falls, MT 59912-3625
Mailing address
305 1St Ave W
Columbia Falls, MT 59912-3625
Phone (406) 249-9153
Other providers in Columbia Falls, MT
- Peter Ivey
- Amanda Jablonsky
- Wayne Emmett Jacobsmeyer
- Colleen Depuydt Johnson
- Kalispell Regional Medical Center, Inc
- Summor Kilgore
- Rachell Kirk
- Anndrea Kraisinger
- Tyler M Ladenburg
- Lahnie Lamb
All providers in Columbia Falls, MT · Mental Health Clinic/Center (Including Community Mental Health Center) in Montana
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Apr 8, 2024. 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.