Provider Demographics
NPI:1407994668
Name:SHEA, MARGARET (LCSW)
Entity type:Individual
Prefix:MS
First Name:MARGARET
Middle Name:
Last Name:SHEA
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:305 S 4TH ST E
Mailing Address - Street 2:SUITE 301
Mailing Address - City:MISSOULA
Mailing Address - State:MT
Mailing Address - Zip Code:59801-2701
Mailing Address - Country:US
Mailing Address - Phone:406-543-2743
Mailing Address - Fax:406-549-9615
Practice Address - Street 1:305 S 4TH ST E
Practice Address - Street 2:SUITE 301
Practice Address - City:MISSOULA
Practice Address - State:MT
Practice Address - Zip Code:59801-2701
Practice Address - Country:US
Practice Address - Phone:406-543-2743
Practice Address - Fax:406-549-9615
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-01
Last Update Date:2010-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT252LCSW101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT70031OtherBLUE CROSS SHIELD