NPIMap

Organization Active NPI

Providence Mental Health PLLC

  • Clinical Social Worker
  • Bozeman, MT
National Provider Identifier
1194291609
Registry record updated Oct 23, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
Legal business name
PROVIDENCE MENTAL HEALTH PLLC
Practice address
2246 Boot Hill CT. Unit #4
Bozeman, MT 59715
Phone
(406) 579-4984
NPI assigned
Oct 23, 2018
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 23, 2018

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Kevin Patrick Maxwell, LCSW
Title
Clinical Director, Clinician
Phone
(406) 579-4984

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Social WorkerGroup: 193200000X MULTI-SPECIALTY GROUP 1041C0700X Primary

Addresses

Primary practice location

2246 Boot Hill CT. Unit #4
Bozeman, MT 59715

Mailing address

2246 Boot Hill CT. Unit #4
Bozeman, MT 59715
Phone (406) 579-4984

National Provider Directory

National Provider Directory

Locations

2246 Boothill Ct
Ste 4
Bozeman, MT 59715
Phone (406) 285-1730

Practitioners & affiliated clinicians

Practitioners 5

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1540252800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1540252800000",
    "number": "1194291609",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2246 BOOT HILL CT. UNIT #4",
            "city": "BOZEMAN",
            "state": "MT",
            "postal_code": "59715",
            "telephone_number": "406-579-4984"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2246 BOOT HILL CT. UNIT #4",
            "city": "BOZEMAN",
            "state": "MT",
            "postal_code": "59715",
            "telephone_number": "406-579-4984"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PROVIDENCE MENTAL HEALTH PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-10-23",
        "last_updated": "2018-10-23",
        "status": "A",
        "authorized_official_last_name": "MAXWELL",
        "authorized_official_first_name": "KEVIN",
        "authorized_official_middle_name": "PATRICK",
        "authorized_official_title_or_position": "CLINICAL DIRECTOR, CLINICIAN",
        "authorized_official_telephone_number": "406-579-4984",
        "authorized_official_credential": "LCSW"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Social Worker, Clinical",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Bozeman, MT

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 23, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.