Healthcare Provider Details

I. General information

NPI: 1730140690
Provider Name (Legal Business Name): DIANE M ADAMS LCSW MAC
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 03/30/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 SOUTH AVE W SUITE A
MISSOULA MT
59801
US

IV. Provider business mailing address

35510 EDS CREEK RD
ALBERTON MT
59820
US

V. Phone/Fax

Practice location:
  • Phone: 406-728-8388
  • Fax:
Mailing address:
  • Phone: 406-728-8388
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number473
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: