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SHAUNDA MARIE ALBERT LAC, MAC, LCSWC

Addiction Substance Use Disorder

Polson, Montana

Provider NPI: 1912407198

Provider Information:
 SHAUNDA MARIE ALBERT LAC, MAC, LCSWC
Gender: F
Sole Proprietor


Practice Location:
302 1ST ST W STE 203  POLSON, MT 59860 US
Tel: 406-270-3447  Fax: --

Business Mailing Address:
42522 CANAL RD  RONAN, MT 59864 US
Tel: 406-270-3447  Fax: --

Entity Type: Individual

Taxonomy:

PrimaryCodeCategory/DescriptionStateLicense Number
Y101YA0400XBehavioral Health & Social Service Providers
Counselor
Addiction (Substance Use Disorder)
MTBBH-LAC-LIC-1275

Other Provider Identifiers:

IssuerNumberStateType
CAQH1380368201
1023525771MT05
LAC LICENSEBBH-LAC-LIC-1275MT01
Code values:
01, Other | 02, Medicare Upin | 04, Medicare Id-Type Unspecified
05, Medicaid | 06, Medicare Oscar/Certification | 07, Medicare NSC | 08, Medicare Pin







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