Provider Demographics
NPI:1245903137
Name:GUIDRY, THOMASINA SHONTAY (LLPC)
Entity type:Individual
Prefix:
First Name:THOMASINA
Middle Name:SHONTAY
Last Name:GUIDRY
Suffix:
Gender:F
Credentials:LLPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5255 LANDS END DR
Mailing Address - Street 2:
Mailing Address - City:KALAMAZOO
Mailing Address - State:MI
Mailing Address - Zip Code:49009-5402
Mailing Address - Country:US
Mailing Address - Phone:517-536-6824
Mailing Address - Fax:
Practice Address - Street 1:5255 LANDS END DR
Practice Address - Street 2:
Practice Address - City:KALAMAZOO
Practice Address - State:MI
Practice Address - Zip Code:49009-5402
Practice Address - Country:US
Practice Address - Phone:517-536-6824
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-27
Last Update Date:2021-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6451019682101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional