Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YP2500X | Professional Counselor | 6401009438 | MI |
NPI | 1003041682 |
---|---|
Provider Name | Rebecca Lynn Guerra |
First Address | Port Huron, MI 48060-3838 |
Second Address | Port Huron, MI 48060-3838 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/05/2009 |
Last Update Date | 26/05/2009 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
101464 | (05) | MI |