Healthcare Provider Details

I. General information

NPI: 1457924631
Provider Name (Legal Business Name): MARVIN COLMAN LAC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/23/2021
Last Update Date: 07/15/2024
Certification Date: 07/15/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1824 N LAST CHANCE GULCH
HELENA MT
59601-0700
US

IV. Provider business mailing address

1824 N LAST CHANCE GULCH
HELENA MT
59601-0700
US

V. Phone/Fax

Practice location:
  • Phone: 406-422-4828
  • Fax:
Mailing address:
  • Phone: 406-422-4828
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberBBH-LAC-LIC-49001
License Number StateMT
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberBBH-LCSW-LIC-70982
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: