Provider Demographics
NPI:1790357630
Name:WEBSTER, ADRIENNE VERELLE (LAC)
Entity Type:Individual
Prefix:
First Name:ADRIENNE
Middle Name:VERELLE
Last Name:WEBSTER
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:226 S BOZEMAN AVE
Mailing Address - Street 2:
Mailing Address - City:BOZEMAN
Mailing Address - State:MT
Mailing Address - Zip Code:59715-4807
Mailing Address - Country:US
Mailing Address - Phone:406-209-4084
Mailing Address - Fax:
Practice Address - Street 1:226 S BOZEMAN AVE
Practice Address - Street 2:
Practice Address - City:BOZEMAN
Practice Address - State:MT
Practice Address - Zip Code:59715-4807
Practice Address - Country:US
Practice Address - Phone:406-209-4084
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-12
Last Update Date:2022-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT47180101YA0400X
MTBBH-LAC-LIC-57462101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)