Provider Demographics
NPI:1780476663
Name:SANTOS GUIJARRO, LIZETTE
Entity type:Individual
Prefix:
First Name:LIZETTE
Middle Name:
Last Name:SANTOS GUIJARRO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3321 ROZA DR
Mailing Address - Street 2:
Mailing Address - City:ZILLAH
Mailing Address - State:WA
Mailing Address - Zip Code:98953-9375
Mailing Address - Country:US
Mailing Address - Phone:509-584-6329
Mailing Address - Fax:
Practice Address - Street 1:400 E UNIVERSITY WAY
Practice Address - Street 2:
Practice Address - City:ELLENSBURG
Practice Address - State:WA
Practice Address - Zip Code:98926-7502
Practice Address - Country:US
Practice Address - Phone:509-963-1111
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-05-19
Last Update Date:2025-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health