# PROVIDENCE MENTAL HEALTH PLLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1194291609
- **Authorized official:** KEVIN PATRICK MAXWELL LCSW (CLINICAL DIRECTOR, CLINICIAN)
- **Authorized official phone:** (406) 579-4984

## Contact information

- **Practice address:** 2246 BOOT HILL CT. UNIT \#4, BOZEMAN, MT 59715
- **Practice address phone:** (406) 579-4984
- **Mailing address:** 2246 BOOT HILL CT. UNIT \#4, BOZEMAN, MT 59715
- **Mailing address phone:** (406) 579-4984

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1041C0700X | Clinical Social Worker | — | NULL | Yes |
| 1041C0700X | Clinical Social Worker | — | — | Yes |

## Other

- **Enumeration date:** 10/23/2018
- **Last updated:** 10/23/2018