Kaoru A Powell, PHD
Individual provider Active NPI Clinical Child & Adolescent Psychologist · Missoula, MT
NPI 1346852043 · NPPES record last updated Oct 10, 2023
Key facts
- NPI
- 1346852043
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Clinical Child & Adolescent Psychologist 103TC2200X
- License
- PSY-PSY-LIC-4549 (MT)
- Practice address
- 1444 Mansfield Ave
Missoula, MT 59812-9794 - Phone
- (406) 219-5938
- NPI assigned
- Aug 24, 2020
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PSY-PSY-LIC-4549 | MT | MD | Clinical Child & Adolescent Psychologist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Bitterroot Psychological Services PLLC | Clinical Child & Adolescent | Current |
Accepting new patients |
Locations
1444 Mansfield Ave
Missoula, MT 59812
Phone (406) 219-5938
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Child & Adolescent Psychologist | 103TC2200X | PSY-PSY-LIC-4549 | MT | Yes |
Addresses
Primary practice location
1444 Mansfield Ave
Missoula, MT 59812-9794
Mailing address
201 Tyler Way
Lolo, MT 59847-9794
Phone (808) 228-9086
Other providers in Missoula, MT
- Jason George Postlethwaite
- Sarah Ann Potts
- Julianne Poulin
- Katelyn Pounds
- Cathryn C Powell
- Kim Alexandre Powell
- Monica Powell
- Stephen George Powell
- Amanda Michele Powers
- Madison Powers
All providers in Missoula, MT · Clinical Child & Adolescent Psychologist in Montana
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Oct 10, 2023. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.