Provider Demographics
NPI:1346690146
Name:GUILHAS, JAMES RANDALL (CSAC)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:RANDALL
Last Name:GUILHAS
Suffix:
Gender:M
Credentials:CSAC
Other - Prefix:
Other - First Name:RANDY
Other - Middle Name:
Other - Last Name:GUILHAS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:CSAC
Mailing Address - Street 1:4514 112TH ST
Mailing Address - Street 2:
Mailing Address - City:CHIPPEWA FALLS
Mailing Address - State:WI
Mailing Address - Zip Code:54729-6652
Mailing Address - Country:US
Mailing Address - Phone:715-225-0642
Mailing Address - Fax:
Practice Address - Street 1:4514 112TH ST
Practice Address - Street 2:
Practice Address - City:CHIPPEWA FALLS
Practice Address - State:WI
Practice Address - Zip Code:54729-6652
Practice Address - Country:US
Practice Address - Phone:715-225-0642
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-13
Last Update Date:2016-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI15762-132101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)