Provider Demographics
NPI:1184842635
Name:GUISINGER, SHAN (PHD)
Entity Type:Individual
Prefix:DR
First Name:SHAN
Middle Name:
Last Name:GUISINGER
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:210 N HIGGINS AVE
Mailing Address - Street 2:STE 310
Mailing Address - City:MISSOULA
Mailing Address - State:MT
Mailing Address - Zip Code:59802-4462
Mailing Address - Country:US
Mailing Address - Phone:406-543-8138
Mailing Address - Fax:
Practice Address - Street 1:210 N HIGGINS AVE
Practice Address - Street 2:STE 310
Practice Address - City:MISSOULA
Practice Address - State:MT
Practice Address - Zip Code:59802-4462
Practice Address - Country:US
Practice Address - Phone:406-543-8138
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT164103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical