Provider Demographics
NPI:1215056676
Name:AHERN-GUZA, DONNA K (M A, LCPC)
Entity type:Individual
Prefix:MS
First Name:DONNA
Middle Name:K
Last Name:AHERN-GUZA
Suffix:
Gender:F
Credentials:M A, LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:104 E MAIN ST
Mailing Address - Street 2:SUITE 409
Mailing Address - City:BOZEMAN
Mailing Address - State:MT
Mailing Address - Zip Code:59715-4760
Mailing Address - Country:US
Mailing Address - Phone:406-570-2922
Mailing Address - Fax:
Practice Address - Street 1:104 E MAIN ST
Practice Address - Street 2:SUITE 409
Practice Address - City:BOZEMAN
Practice Address - State:MT
Practice Address - Zip Code:59715-4760
Practice Address - Country:US
Practice Address - Phone:406-570-2922
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTLCPC 515101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT0000074545OtherBLUE CROSS BLUE SHIELD