Healthcare Provider Details

I. General information

NPI: 1467519785
Provider Name (Legal Business Name): EDWARD KENNETH ESQUIBEL MSW LCSW MASTERS OF
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/03/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

315 W GRANITE
BUTTE MT
59701
US

IV. Provider business mailing address

BOX 704 315 W GRANITE
BUTTE MT
59701
US

V. Phone/Fax

Practice location:
  • Phone: 406-782-8750
  • Fax:
Mailing address:
  • Phone: 406-782-8750
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number226
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: