Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YM0800X | Mental Health Counselor | OK | |
N | 103TH0100X | Health Service |
NPI | 1083966659 |
---|---|
Provider Name | Yvette Maria Guereca |
First Address | Tampa, FL 33612-4745 |
Second Address | Tampa, FL 33612 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/10/2012 |
Last Update Date | 16/04/2019 |