Provider Demographics
NPI:1467519785
Name:ESQUIBEL, EDWARD KENNETH (MSW LCSW MASTERS OF)
Entity Type:Individual
Prefix:MR
First Name:EDWARD
Middle Name:KENNETH
Last Name:ESQUIBEL
Suffix:
Gender:M
Credentials:MSW LCSW MASTERS OF
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:BOX 704
Mailing Address - Street 2:315 W GRANITE
Mailing Address - City:BUTTE
Mailing Address - State:MT
Mailing Address - Zip Code:59701
Mailing Address - Country:US
Mailing Address - Phone:406-782-8750
Mailing Address - Fax:
Practice Address - Street 1:315 W GRANITE
Practice Address - Street 2:
Practice Address - City:BUTTE
Practice Address - State:MT
Practice Address - Zip Code:59701
Practice Address - Country:US
Practice Address - Phone:406-782-8750
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT2261041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT0000501540Medicaid
MT71240OtherBCBS