Provider Demographics
NPI:1821835208
Name:GIESE, JUSTIN (SWLC)
Entity type:Individual
Prefix:
First Name:JUSTIN
Middle Name:
Last Name:GIESE
Suffix:
Gender:M
Credentials:SWLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30 2ND ST E # B26
Mailing Address - Street 2:
Mailing Address - City:KALISPELL
Mailing Address - State:MT
Mailing Address - Zip Code:59901-4563
Mailing Address - Country:US
Mailing Address - Phone:763-442-7972
Mailing Address - Fax:
Practice Address - Street 1:30 2ND ST E # B26
Practice Address - Street 2:
Practice Address - City:KALISPELL
Practice Address - State:MT
Practice Address - Zip Code:59901-4563
Practice Address - Country:US
Practice Address - Phone:763-442-7972
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-11
Last Update Date:2024-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTBBH-SWLC-LIC-714601041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical