Provider Demographics
| NPI: | 1780980011 |
|---|---|
| Name: | THE CENTER FOR CHILDREN AND FAMILIES |
| Entity type: | Organization |
| Organization Name: | THE CENTER FOR CHILDREN AND FAMILIES |
| Other - Org Name: | <UNAVAIL> |
| Other - Org Type: | |
| Authorized Official - Title/Position: | DIRECTOR OF CLINICAL AND EVALUATION |
| Authorized Official - Prefix: | DR |
| Authorized Official - First Name: | BRENDA |
| Authorized Official - Middle Name: | K |
| Authorized Official - Last Name: | ROCHE |
| Authorized Official - Suffix: | |
| Authorized Official - Credentials: | PHD |
| Authorized Official - Phone: | 406-672-6201 |
| Mailing Address - Street 1: | 1501 14TH ST W |
| Mailing Address - Street 2: | SUITE 230 |
| Mailing Address - City: | BILLINGS |
| Mailing Address - State: | MT |
| Mailing Address - Zip Code: | 59102-3150 |
| Mailing Address - Country: | US |
| Mailing Address - Phone: | 406-294-5090 |
| Mailing Address - Fax: | 406-294-9512 |
| Practice Address - Street 1: | 1501 14TH ST W |
| Practice Address - Street 2: | SUITE 230 |
| Practice Address - City: | BILLINGS |
| Practice Address - State: | MT |
| Practice Address - Zip Code: | 59102-3150 |
| Practice Address - Country: | US |
| Practice Address - Phone: | 406-294-5090 |
| Practice Address - Fax: | 406-294-9512 |
| EIN: | <UNAVAIL> |
| Is Organization Subpart?: | No |
| Parent Organization LBN: | |
| Parent Organization TIN: | |
| Enumeration Date: | 2011-02-03 |
| Last Update Date: | 2011-02-03 |
| Deactivation Date: | |
| Deactivation Code: | |
| Reactivation Date: |
Provider Licenses
| State | License ID | Taxonomies |
|---|---|---|
| MT | 357 | 103T00000X, 103TA0400X, 103TB0200X, 103TC0700X, 103TC1900X, 103TC2200X, 103TF0000X, 103TF0200X, 103TP2701X, 261QM0801X, 103G00000X |
Provider Taxonomies
| Primary? | Code | Type | Classification | Specialization | Group |
|---|---|---|---|---|---|
| Yes | 103G00000X | Behavioral Health & Social Service Providers | Clinical Neuropsychologist | Group - Multi-Specialty | |
| No | 103T00000X | Behavioral Health & Social Service Providers | Psychologist | Group - Multi-Specialty | |
| No | 103TA0400X | Behavioral Health & Social Service Providers | Psychologist | Addiction (Substance Use Disorder) | Group - Multi-Specialty |
| No | 103TB0200X | Behavioral Health & Social Service Providers | Psychologist | Cognitive & Behavioral | Group - Multi-Specialty |
| No | 103TC0700X | Behavioral Health & Social Service Providers | Psychologist | Clinical | Group - Multi-Specialty |
| No | 103TC1900X | Behavioral Health & Social Service Providers | Psychologist | Counseling | Group - Multi-Specialty |
| No | 103TC2200X | Behavioral Health & Social Service Providers | Psychologist | Clinical Child & Adolescent | Group - Multi-Specialty |
| No | 103TF0000X | Behavioral Health & Social Service Providers | Psychologist | Family | Group - Multi-Specialty |
| No | 103TF0200X | Behavioral Health & Social Service Providers | Psychologist | Forensic | Group - Multi-Specialty |
| No | 103TP2701X | Behavioral Health & Social Service Providers | Psychologist | Group Psychotherapy | Group - Multi-Specialty |
| No | 261QM0801X | Ambulatory Health Care Facilities | Clinic/Center | Mental Health (Including Community Mental Health Center) | Group - Multi-Specialty |
Provider Identifiers
| State | Identifier ID | ID Type | Issuer |
|---|---|---|---|
| MT | 0000052431 | Other | BLUE CROSS BLUE SHIELD |
| MT | 0000147355 | Medicaid |
