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General NPI Number Information
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NPI Number | 1477420230
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Entity Type | Organization
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Legal Business Name | ADAM BOOMER LLC
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Dates
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Enumeration Date | 10/17/2025
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Last Update Date | 10/24/2025
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Provider Practice Location Address
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Address Line | 800 KENSINGTON AVE STE 201
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City | MISSOULA
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State | MT
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Zip | 59801-5670
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Country | US
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Telephone | 406-830-5095
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Fax |
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Provider Business Mailing Address
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Address Line | 800 KENSINGTON AVE STE 201
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City | MISSOULA
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State | MT
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Zip | 59801-5674
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Country | US
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Telephone | 406-830-5095
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Fax |
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Authorized Official
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Title or Position | THERAPIST
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Name | ADAM BOOMER
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Credential | BBH-LCSW-LIC-81440
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Telephone | 406-830-5095
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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 |
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License Number State |
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