Provider Demographics
NPI:1487951869
Name:GUILLEN, MARCO (LMFT)
Entity type:Individual
Prefix:
First Name:MARCO
Middle Name:
Last Name:GUILLEN
Suffix:
Gender:M
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3109 VIA BREVE
Mailing Address - Street 2:
Mailing Address - City:MONTEBELLO
Mailing Address - State:CA
Mailing Address - Zip Code:90640-2204
Mailing Address - Country:US
Mailing Address - Phone:323-707-7621
Mailing Address - Fax:
Practice Address - Street 1:3109 VIA BREVE
Practice Address - Street 2:
Practice Address - City:MONTEBELLO
Practice Address - State:CA
Practice Address - Zip Code:90640-2204
Practice Address - Country:US
Practice Address - Phone:323-707-7621
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-02-18
Last Update Date:2011-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA43686106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist