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General NPI Number Information
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NPI Number | 1285057232
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Entity Type | Individual
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Provider Name | ROULA AGNE LCSW
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Gender | Female
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Dates
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Enumeration Date | 01/28/2014
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 415 N HIGGINS AVE
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City | MISSOULA
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State | MT
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Zip | 59802-4557
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Country | US
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Telephone | 406-531-2416
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Fax | 855-201-3734
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Provider Business Mailing Address
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Address Line | PO BOX 3236
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City | MISSOULA
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State | MT
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Zip | 59806-3236
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Country | US
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Telephone | 406-531-2416
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Fax | 855-201-3734
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 4642
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License Number State | MT
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