Provider Demographics
NPI:1518504596
Name:OFFICE OF RANDY GUINARD, LCSW LLC
Entity Type:Organization
Organization Name:OFFICE OF RANDY GUINARD, LCSW LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:SINDY
Authorized Official - Middle Name:
Authorized Official - Last Name:FILLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:406-293-3993
Mailing Address - Street 1:703 CALIFORNIA AVENUE
Mailing Address - Street 2:
Mailing Address - City:LIBBY
Mailing Address - State:MT
Mailing Address - Zip Code:59923
Mailing Address - Country:US
Mailing Address - Phone:406-293-3993
Mailing Address - Fax:406-293-3990
Practice Address - Street 1:703 CALIFORNIA AVENUE
Practice Address - Street 2:
Practice Address - City:LIBBY
Practice Address - State:MT
Practice Address - Zip Code:59923
Practice Address - Country:US
Practice Address - Phone:406-293-3993
Practice Address - Fax:406-293-3990
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-12-09
Last Update Date:2020-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT7141734Medicaid