Provider Demographics
NPI:1639923691
Name:BITTERROOT BEHAVIORAL HEALTH LLC
Entity Type:Organization
Organization Name:BITTERROOT BEHAVIORAL HEALTH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BLYTHE
Authorized Official - Middle Name:
Authorized Official - Last Name:SIEBENALLER
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:406-662-1050
Mailing Address - Street 1:320 N 1ST ST STE G
Mailing Address - Street 2:
Mailing Address - City:HAMILTON
Mailing Address - State:MT
Mailing Address - Zip Code:59840-2569
Mailing Address - Country:US
Mailing Address - Phone:406-662-1050
Mailing Address - Fax:
Practice Address - Street 1:320 N 1ST ST STE G
Practice Address - Street 2:
Practice Address - City:HAMILTON
Practice Address - State:MT
Practice Address - Zip Code:59840-2569
Practice Address - Country:US
Practice Address - Phone:406-662-1050
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-04-16
Last Update Date:2024-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty