# BITTERROOT PSYCHOLOGICAL SERVICES PLLC

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

## Provider details

- **NPI number:** 1598546103
- **Authorized official:** DR. KAORU POWELL PHD (CLINICAL PSYCHOLOGIST)
- **Authorized official phone:** (406) 219-5938

## Contact information

- **Practice address:** 1444 MANSFIELD AVE, MISSOULA, MT 59812-0001
- **Practice address phone:** (406) 219-5938
- **Mailing address:** 201 TYLER WAY, LOLO, MT 59847-9794

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 103TC2200X | Clinical Child & Adolescent Psychologist | — | NULL | Yes |
| 103TC2200X | Clinical Child & Adolescent Psychologist | — | — | Yes |

## Other

- **Enumeration date:** 10/10/2023
- **Last updated:** 11/07/2023