=====================================================
General NPI Number Information
=====================================================
NPI Number | 1558278879
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MERRY HEARTS MONTANA
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/24/2026
-----------------------------------------------------
Last Update Date | 08/24/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 211 SWEETGRASS AVE
-----------------------------------------------------
City | BOZEMAN
-----------------------------------------------------
State | MT
-----------------------------------------------------
Zip | 59718-2698
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 406-219-7769
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 211 SWEETGRASS AVE
-----------------------------------------------------
City | BOZEMAN
-----------------------------------------------------
State | MT
-----------------------------------------------------
Zip | 59718-2698
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 406-219-7769
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | ADRIANNE V WALLACE
-----------------------------------------------------
Credential | LMFT
-----------------------------------------------------
Telephone | 406-219-7769
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QM0801X
-----------------------------------------------------
Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------