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General NPI Number Information
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NPI Number | 1124979083
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Entity Type | Organization
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Legal Business Name | PONDEROSA HEALING WATERS
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Dates
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Enumeration Date | 02/06/2026
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Last Update Date | 02/06/2026
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Provider Practice Location Address
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Address Line | 42064 KENNEDY DR
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City | RONAN
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State | MT
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Zip | 59864-9359
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Country | US
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Telephone | 406-880-7305
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 548
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City | RONAN
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State | MT
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Zip | 59864-0548
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Country | US
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Telephone | 406-880-7305
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Fax |
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Authorized Official
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Title or Position | PROVIDER
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Name | ANGELA CHRISTINE EVANS
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Credential | LAC, SWLC
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Telephone | 406-880-7305
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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License Number |
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License Number State |
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