Provider Demographics
NPI:1447650668
Name:DADMUN, MARK (MA)
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:
Last Name:DADMUN
Suffix:
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 W BROADWAY ST
Mailing Address - Street 2:SUITE 101 - BOX 329
Mailing Address - City:MISSOULA
Mailing Address - State:MT
Mailing Address - Zip Code:59802
Mailing Address - Country:US
Mailing Address - Phone:406-333-6975
Mailing Address - Fax:
Practice Address - Street 1:210 N HIGGINS AVE STE 227
Practice Address - Street 2:
Practice Address - City:MISSOULA
Practice Address - State:MT
Practice Address - Zip Code:59802-4497
Practice Address - Country:US
Practice Address - Phone:406-333-6975
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-25
Last Update Date:2023-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health