Provider Demographics
NPI:1477070738
Name:SARA BOILEN, PSYD, PLLC
Entity Type:Organization
Organization Name:SARA BOILEN, PSYD, PLLC
Other - Org Name:SWEETGRASS PSYCHOLOGICAL A SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SARA
Authorized Official - Middle Name:
Authorized Official - Last Name:BOILEN
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:406-662-1771
Mailing Address - Street 1:50 2ND ST W STE 300
Mailing Address - Street 2:
Mailing Address - City:WHITEFISH
Mailing Address - State:MT
Mailing Address - Zip Code:59937-3067
Mailing Address - Country:US
Mailing Address - Phone:406-662-1771
Mailing Address - Fax:
Practice Address - Street 1:144 2ND ST W UNIT A
Practice Address - Street 2:
Practice Address - City:WHITEFISH
Practice Address - State:MT
Practice Address - Zip Code:59937-3075
Practice Address - Country:US
Practice Address - Phone:406-662-1771
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-08-28
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT18309101YP2500X
MT1196103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT7209748Medicaid