MEDICARE: ADAM INTERMONT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YA0400X	Addiction (Substance Use Disorder) Counselor

General Provider Information

NPI Number	:	1346660800
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ADAM INTERMONT

Provider Business Mailing Address
First Line	:	842 SAN ANTONIO PL
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80906-4907
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3520 GALLEY RD STE 203
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80909-4344
Country	:	US
Telephone Number	:	719-570-4322
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/23/2014
Last Update Date	:	04/23/2014

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Directions to “ ADAM INTERMONT ” Practice Location

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