Healthcare Provider Details

I. General information

NPI: 1881290302
Provider Name (Legal Business Name): BOULE SOPHIA LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/09/2020
Last Update Date: 02/19/2026
Certification Date: 02/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

41582 BAYPOINT RD
POLSON MT
59860-8584
US

IV. Provider business mailing address

PO BOX 1642
POLSON MT
59860-1642
US

V. Phone/Fax

Practice location:
  • Phone: 406-491-2898
  • Fax:
Mailing address:
  • Phone: 406-491-2898
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: ERIKA ANNE WEBER
Title or Position: OWNER/PROVIDER
Credential: LCSW
Phone: 406-491-2898