Provider Demographics
NPI:1912407198
Name:ALBERT, SHAUNDA MARIE (LAC, MAC, LCSW)
Entity Type:Individual
Prefix:
First Name:SHAUNDA
Middle Name:MARIE
Last Name:ALBERT
Suffix:
Gender:F
Credentials:LAC, MAC, LCSW
Other - Prefix:
Other - First Name:SHAUNDA
Other - Middle Name:MARIE
Other - Last Name:ALBERT
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:42522 CANAL RD
Mailing Address - Street 2:
Mailing Address - City:RONAN
Mailing Address - State:MT
Mailing Address - Zip Code:59864-9002
Mailing Address - Country:US
Mailing Address - Phone:406-270-3447
Mailing Address - Fax:
Practice Address - Street 1:302 1ST ST W STE 203
Practice Address - Street 2:
Practice Address - City:POLSON
Practice Address - State:MT
Practice Address - Zip Code:59860-2602
Practice Address - Country:US
Practice Address - Phone:406-270-3447
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-02-14
Last Update Date:2021-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT502021041C0700X
MTBBH-LAC-LIC-1275101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MTBBH-LAC-LIC-1275OtherLAC LICENSE
MT1023525771Medicaid
13803682OtherCAQH