Provider Demographics
NPI:1730755653
Name:GARNEAU, JUSTUS LEE
Entity type:Individual
Prefix:
First Name:JUSTUS
Middle Name:LEE
Last Name:GARNEAU
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 562
Mailing Address - Street 2:
Mailing Address - City:BEACH
Mailing Address - State:ND
Mailing Address - Zip Code:58621-0562
Mailing Address - Country:US
Mailing Address - Phone:701-872-6152
Mailing Address - Fax:
Practice Address - Street 1:67 1ST ST SE
Practice Address - Street 2:
Practice Address - City:BEACH
Practice Address - State:ND
Practice Address - Zip Code:58621
Practice Address - Country:US
Practice Address - Phone:701-872-6152
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-01
Last Update Date:2025-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
171M00000X
ND1155-9-15-21101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No171M00000XOther Service ProvidersCase Manager/Care Coordinator