Healthcare Provider Details

I. General information

NPI: 1356885602
Provider Name (Legal Business Name): ABIGAIL GUZA LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/06/2016
Last Update Date: 03/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 KENSINGTON AVE STE LL2
MISSOULA MT
59801-5670
US

IV. Provider business mailing address

2615 ARCADIA DR
MISSOULA MT
59803-2020
US

V. Phone/Fax

Practice location:
  • Phone: 406-546-2665
  • Fax:
Mailing address:
  • Phone: 406-459-6989
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number19762
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: