| Boule Sophia Llc | |
|
41582 Baypoint Rd Polson MT 59860-8584 | |
| (406) 491-2898 | |
| Not Available |
| Full Name | Boule Sophia Llc |
|---|---|
| Speciality | Clinic/Center |
| Location | 41582 Baypoint Rd, Polson, Montana |
| Authorized Official Name and Position | Erika Anne Weber (OWNER/PROVIDER) |
| Authorized Official Contact | 4064912898 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Boule Sophia Llc Po Box 1642 Polson MT 59860-1642 Ph: (406) 491-2898 | Boule Sophia Llc 41582 Baypoint Rd Polson MT 59860-8584 Ph: (406) 491-2898 |
| NPI Number | 1881290302 |
|---|---|
| Provider Enumeration Date | 12/09/2020 |
| Last Update Date | 12/09/2020 |
| Certification Date | 12/09/2020 |
| Medicare PECOS PAC ID | 4082029020 |
|---|---|
| Medicare Enrollment ID | O20210224002138 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1881290302 | NPI | - | NPPES |
| 1200619724101 | Other | MT | DRIVERS LICENSE |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0801X | Clinic/center - Mental Health (including Community Mental Health Center) | (* (Not Available)) | Primary |
| Provider Name | Erika A Weber |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1114220787 PECOS PAC ID: 6305035916 Enrollment ID: I20110113000432 |
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