Healthcare Provider Details

I. General information

NPI: 1568036465
Provider Name (Legal Business Name): LAWANA V MCGUFFEY ACLC, SWLC, MSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/14/2021
Last Update Date: 10/17/2024
Certification Date: 10/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

305 MAIN AVE
SUPERIOR MT
59872-8515
US

IV. Provider business mailing address

PO BOX 298
SUPERIOR MT
59872-0298
US

V. Phone/Fax

Practice location:
  • Phone: 406-396-8032
  • Fax:
Mailing address:
  • Phone: 406-396-8032
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number43493
License Number StateMT
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number43492
License Number StateMT
# 3
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberBBH-LCSW-LIC-62712
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: