Healthcare Provider Details

I. General information

NPI: 1790034486
Provider Name (Legal Business Name): JAMES WILLIAM GUERRANT LMSW-CC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/10/2012
Last Update Date: 01/26/2022
Certification Date: 01/26/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1535 42ND ST S STE 400
FARGO ND
58103-3383
US

IV. Provider business mailing address

1535 42ND ST S STE 400
FARGO ND
58103-3383
US

V. Phone/Fax

Practice location:
  • Phone: 701-715-8567
  • Fax: 701-540-0098
Mailing address:
  • Phone: 701-715-8567
  • Fax: 701-540-0098

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number5222
License Number StateND
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMC14322
License Number StateME

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier1790034486
Identifier TypeMEDICAID
Identifier StateME
Identifier Issuer

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: