MEDICARE: JAMES RANDALL GUILHAS CSAC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YA0400X	Addiction (Substance Use Disorder) Counselor	15762-132	WI

General Provider Information

NPI Number	:	1346690146
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JAMES RANDALL GUILHAS CSAC

Provider Business Mailing Address
First Line	:	4514 112TH ST
Second Line	:
City	:	CHIPPEWA FALLS
State	:	WI
Zip	:	54729-6652
Country	:	US
Telephone Number	:	715-225-0642
Fax Number	:

Provider Business Practice Location Address
First Line	:	4514 112TH ST
Second Line	:
City	:	CHIPPEWA FALLS
State	:	WI
Zip	:	54729-6652
Country	:	US
Telephone Number	:	715-225-0642
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/13/2016
Last Update Date	:	06/13/2016

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