MEDICARE: MRS. KATJA-LARISSA GUINN LMFT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106H00000X	Marriage & Family Therapist	203960	TX

General Provider Information

NPI Number	:	1093842379
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. KATJA-LARISSA GUINN LMFT

Provider Business Mailing Address
First Line	:	6800 PARK TEN BLVD STE 200S
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78213-4293
Country	:	US
Telephone Number	:	210-261-1060
Fax Number	:	210-261-1821

Provider Business Practice Location Address
First Line	:	601 N FRIO ST BLDG 2
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78207-3011
Country	:	US
Telephone Number	:	210-261-3001
Fax Number	:	210-731-9661

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/27/2007
Last Update Date	:	11/03/2023

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