Provider Demographics
NPI:1184452567
Name:CLINICAL PSYCHOLOGY CENTER
Entity type:Organization
Organization Name:CLINICAL PSYCHOLOGY CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:RAURIE
Authorized Official - Middle Name:ELIZABETH
Authorized Official - Last Name:BIRCH
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:406-243-2367
Mailing Address - Street 1:1444 MANSFIELD AVE
Mailing Address - Street 2:
Mailing Address - City:MISSOULA
Mailing Address - State:MT
Mailing Address - Zip Code:59812
Mailing Address - Country:US
Mailing Address - Phone:406-243-2367
Mailing Address - Fax:406-243-5549
Practice Address - Street 1:1444 MANSFIELD AVE
Practice Address - Street 2:
Practice Address - City:MISSOULA
Practice Address - State:MT
Practice Address - Zip Code:59812
Practice Address - Country:US
Practice Address - Phone:406-243-2367
Practice Address - Fax:406-243-5549
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-07-25
Last Update Date:2024-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training ProgramGroup - Single Specialty