Healthcare Provider Details

I. General information

NPI: 1902796188
Provider Name (Legal Business Name): RUTH BARBOUR PCLC, ACLC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/08/2025
Last Update Date: 07/08/2025
Certification Date: 07/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2620 CONNERY WAY
MISSOULA MT
59808-1325
US

IV. Provider business mailing address

1802 HILDA AVE
MISSOULA MT
59801-5913
US

V. Phone/Fax

Practice location:
  • Phone: 406-203-9948
  • Fax: 406-203-9949
Mailing address:
  • Phone: 262-422-7471
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberBBH-PCLC-LIC-80145
License Number StateMT
# 2
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberBBH-ACLC-LIC-80838
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: