Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TC1900X | Counseling Psychologist | 1201 | LA |
NPI | 1073752358 |
---|---|
Provider Name | Dr. Adam Joseph Guilmino |
First Address | Morgan City, LA 70380-2247 |
Second Address | Morgan City, LA 70380-2247 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/02/2009 |
Last Update Date | 11/02/2009 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
LICENSE # 1201 | LICENSED PSYCHOLOGIST STATE OF LOUISIANA (01) | LA |
LP5022 | MN LICENSE NUMBER (01) | MN |