Provider Demographics
NPI:1437505674
Name:MOLLER, ADAM (PHD)
Entity Type:Individual
Prefix:DR
First Name:ADAM
Middle Name:
Last Name:MOLLER
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:121 W KAGY BLVD STE N
Mailing Address - Street 2:
Mailing Address - City:BOZEMAN
Mailing Address - State:MT
Mailing Address - Zip Code:59715-6042
Mailing Address - Country:US
Mailing Address - Phone:406-577-1010
Mailing Address - Fax:
Practice Address - Street 1:121 W KAGY BLVD STE N
Practice Address - Street 2:
Practice Address - City:BOZEMAN
Practice Address - State:MT
Practice Address - Zip Code:59715-6042
Practice Address - Country:US
Practice Address - Phone:406-577-1010
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-06
Last Update Date:2024-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTPSY-PSY-LIC-1954103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist