Provider Demographics
NPI:1487860730
Name:BITTERROOT VALLEY EDUCATION COOPERATIVE
Entity Type:Organization
Organization Name:BITTERROOT VALLEY EDUCATION COOPERATIVE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:
Authorized Official - Last Name:MILLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:406-777-2494
Mailing Address - Street 1:300 PARK ST
Mailing Address - Street 2:PO BOX 187
Mailing Address - City:STEVENSVILLE
Mailing Address - State:MT
Mailing Address - Zip Code:59870-2603
Mailing Address - Country:US
Mailing Address - Phone:406-777-2494
Mailing Address - Fax:406-777-2495
Practice Address - Street 1:300 PARK ST
Practice Address - Street 2:
Practice Address - City:STEVENSVILLE
Practice Address - State:MT
Practice Address - Zip Code:59870-2603
Practice Address - Country:US
Practice Address - Phone:406-777-2494
Practice Address - Fax:406-777-2495
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-15
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT1082101YP2500X
MT7461041C0700X
MT11089251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty
Not Answered1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Not Answered251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT256598Medicaid
MT350795Medicaid
MT503489Medicaid