Provider Demographics
NPI:1508299538
Name:GUIDOS, JEREMIAH (LCPC)
Entity Type:Individual
Prefix:
First Name:JEREMIAH
Middle Name:
Last Name:GUIDOS
Suffix:
Gender:M
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 410
Mailing Address - Street 2:
Mailing Address - City:HERON
Mailing Address - State:MT
Mailing Address - Zip Code:59844-0410
Mailing Address - Country:US
Mailing Address - Phone:406-847-5095
Mailing Address - Fax:
Practice Address - Street 1:26 ASPEN LANE
Practice Address - Street 2:
Practice Address - City:HERON
Practice Address - State:MT
Practice Address - Zip Code:59844
Practice Address - Country:US
Practice Address - Phone:406-847-5095
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-13
Last Update Date:2014-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLCPC 5633101YP2500X
MTSWP-LCPC-LIC-8307101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional