Provider Demographics
NPI:1417390493
Name:BITTERROOT MENTAL HEALTH, INC.
Entity Type:Organization
Organization Name:BITTERROOT MENTAL HEALTH, INC.
Other - Org Name:BITTERROOT MENTAL WELLNESS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:STEPHANIE
Authorized Official - Middle Name:
Authorized Official - Last Name:BARKER-LACHAPELLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:208-755-6992
Mailing Address - Street 1:2540 W BERKLEY LN
Mailing Address - Street 2:
Mailing Address - City:HAYDEN
Mailing Address - State:ID
Mailing Address - Zip Code:83835-8038
Mailing Address - Country:US
Mailing Address - Phone:208-755-6992
Mailing Address - Fax:
Practice Address - Street 1:162 S 2ND ST
Practice Address - Street 2:
Practice Address - City:HAMILTON
Practice Address - State:MT
Practice Address - Zip Code:59840-2517
Practice Address - Country:US
Practice Address - Phone:405-363-4695
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-04-09
Last Update Date:2013-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT251B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management