MEDICARE: PAUL EDWARD BOLAND

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	BBH-ACLC-LIC-62848	MT
2	101YP2500X	Professional Counselor	BBH-PCLC-LIC-64476	MT

General Provider Information

NPI Number	:	1912777996
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PAUL EDWARD BOLAND

Provider Business Mailing Address
First Line	:	3605 FAIRWAY DR
Second Line	:
City	:	GREAT FALLS
State	:	MT
Zip	:	59401-2284
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3605 FAIRWAY DR
Second Line	:
City	:	GREAT FALLS
State	:	MT
Zip	:	59401-2284
Country	:	US
Telephone Number	:	406-231-4588
Fax Number	:

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

Provider Enumeration Date	:	01/02/2024
Last Update Date	:	04/03/2024

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Directions to “ PAUL EDWARD BOLAND ” Practice Location

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