Individual
SHANICO ALLEN CHRISTOPHER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
SWLC
Contact information
Practice address
690 SW HIGGINS AVE STE A, MISSOULA, MT 59803-1433
(406) 396-6788
Mailing address
PO BOX 3351, MISSOULA, MT 59806-3351
(406) 396-6788
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
BBH-SWLC-LIC-72166
MT
Other
Enumeration date
07/18/2024
Last updated
07/18/2024
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