Provider Demographics
NPI:1609841022
Name:CLADOUHOS-POWELL, ROBERTA SUE (LCPC)
Entity Type:Individual
Prefix:
First Name:ROBERTA
Middle Name:SUE
Last Name:CLADOUHOS-POWELL
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 3089
Mailing Address - Street 2:CENTER FOR MENTAL HEALTH
Mailing Address - City:GREAT FALLS
Mailing Address - State:MT
Mailing Address - Zip Code:59403-3089
Mailing Address - Country:US
Mailing Address - Phone:406-761-2100
Mailing Address - Fax:406-761-2107
Practice Address - Street 1:4119 7TH AVE N
Practice Address - Street 2:CENTER FOR MENTAL HEALTH/MORNINGSIDE ELEMENTARY
Practice Address - City:GREAT FALLS
Practice Address - State:MT
Practice Address - Zip Code:59405-1119
Practice Address - Country:US
Practice Address - Phone:406-750-4139
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-02-20
Last Update Date:2009-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT983 LCPC101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT0000744903OtherBLUE CROSS-SHIELD OF MONTANA - CENTER FOR MENTAL HEALTH
MT0257387Medicaid
MT743370OtherBLUE CROSS BLUE SHIELD