Healthcare Provider Details

I. General information

NPI: 1487860730
Provider Name (Legal Business Name): BITTERROOT VALLEY EDUCATION COOPERATIVE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/15/2007
Last Update Date: 12/13/2024
Certification Date: 12/13/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 PARK ST
STEVENSVILLE MT
59870-2603
US

IV. Provider business mailing address

300 PARK ST PO BOX 187
STEVENSVILLE MT
59870-2603
US

V. Phone/Fax

Practice location:
  • Phone: 406-777-2494
  • Fax: 406-777-2495
Mailing address:
  • Phone: 406-777-2494
  • Fax: 406-777-2495

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number1082
License Number StateMT
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number746
License Number StateMT
# 3
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number11089
License Number StateMT
# 4
Primary TaxonomyN
Taxonomy Code322D00000X
TaxonomyEmotionally Disturbed Childrens' Residential Treatment Facility
License Number
License Number State

VIII. Authorized Official

Name: JILL REYNOLDS
Title or Position: BUSINESS MANAGER
Credential:
Phone: 406-777-2494