Basic Information
| Provider Information | |||||||||
| NPI: | 1093842379 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | GUINN | ||||||||
| FirstName: | KATJA-LARISSA | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | MRS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | LMFT | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | MILLS | ||||||||
| OtherFirstName: | KATJA-LARISSA | ||||||||
| OtherMiddleName: | |||||||||
| OtherNamePrefix: | MISS | ||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | LMFT | ||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 754 E ARROW HWY | ||||||||
| Address2: | SUITE F | ||||||||
| City: | COVINA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 917222107 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6269675082 | ||||||||
| FaxNumber: | 6268595002 | ||||||||
| Practice Location | |||||||||
| Address1: | 754 E ARROW HWY | ||||||||
| Address2: | SUITE F | ||||||||
| City: | COVINA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 917222107 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6269675082 | ||||||||
| FaxNumber: | 6268595002 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/27/2007 | ||||||||
| LastUpdateDate: | 05/18/2009 | ||||||||
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| NPIReactivationDate: | |||||||||
| ProviderGenderCode: | F | ||||||||
| AuthorizedOfficialLastName: | |||||||||
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| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | |||||||||
| AuthorizedOfficialTelephone: | |||||||||
| IsSoleProprietor: | Y | ||||||||
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| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 106H00000X | MFC39581 | CA | Y | Behavioral Health & Social Service Providers | Marriage & Family Therapist |
No ID Information.