Provider Demographics
NPI:1487672978
Name:SHILTS, GUY W (MS, LMFT, LCSW, LPC)
Entity Type:Individual
Prefix:
First Name:GUY
Middle Name:W
Last Name:SHILTS
Suffix:
Gender:M
Credentials:MS, LMFT, LCSW, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17 S RIVER
Mailing Address - Street 2:STE 254
Mailing Address - City:JANESVILLE
Mailing Address - State:WI
Mailing Address - Zip Code:53548
Mailing Address - Country:US
Mailing Address - Phone:608-755-5260
Mailing Address - Fax:608-775-5526
Practice Address - Street 1:17 S RIVER
Practice Address - Street 2:STE 254
Practice Address - City:JANESVILLE
Practice Address - State:WI
Practice Address - Zip Code:53548
Practice Address - Country:US
Practice Address - Phone:608-755-5260
Practice Address - Fax:608-775-5526
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI513125101Y00000X
WI3109123103T00000X
WI176124106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101Y00000XBehavioral Health & Social Service ProvidersCounselor
Not Answered103T00000XBehavioral Health & Social Service ProvidersPsychologist
Not Answered106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist