Provider Demographics
NPI:1457129447
Name:WESTERN, ADAM SR (LADC MA BS)
Entity Type:Individual
Prefix:MR
First Name:ADAM
Middle Name:
Last Name:WESTERN
Suffix:SR
Gender:M
Credentials:LADC MA BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8212 GARFIELD AVE S
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGTON
Mailing Address - State:MN
Mailing Address - Zip Code:55420-2227
Mailing Address - Country:US
Mailing Address - Phone:407-789-0500
Mailing Address - Fax:
Practice Address - Street 1:8212 GARFIELD AVE S
Practice Address - Street 2:
Practice Address - City:BLOOMINGTON
Practice Address - State:MN
Practice Address - Zip Code:55420-2227
Practice Address - Country:US
Practice Address - Phone:407-789-0500
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-12-19
Last Update Date:2023-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty