Organization
PROVIDENCE MENTAL HEALTH PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KEVIN PATRICK MAXWELL LCSW (CLINICAL DIRECTOR, CLINICIAN)
(406) 579-4984
Entity
Organization
Contact information
Practice address
2246 BOOT HILL CT. UNIT #4, BOZEMAN, MT 59715
(406) 579-4984
Mailing address
2246 BOOT HILL CT. UNIT #4, BOZEMAN, MT 59715
(406) 579-4984
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
—
—
Other
Enumeration date
10/23/2018
Last updated
10/23/2018
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