Provider Demographics
NPI:1790034486
Name:GUERRANT, JAMES WILLIAM (LMSW-CC)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:WILLIAM
Last Name:GUERRANT
Suffix:
Gender:M
Credentials:LMSW-CC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1535 42ND ST S
Mailing Address - Street 2:STE 400
Mailing Address - City:FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58103-3383
Mailing Address - Country:US
Mailing Address - Phone:701-715-8567
Mailing Address - Fax:701-540-0098
Practice Address - Street 1:1535 42ND ST S STE 400
Practice Address - Street 2:
Practice Address - City:FARGO
Practice Address - State:ND
Practice Address - Zip Code:58103-3383
Practice Address - Country:US
Practice Address - Phone:701-715-8567
Practice Address - Fax:701-540-0098
Is Sole Proprietor?:No
Enumeration Date:2012-09-10
Last Update Date:2022-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND52221041C0700X
MEMC14322101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME1790034486Medicaid