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NPI Code Detail

MEDICARE: NICHOLAS GUILLEN COUPLE

MEDICARE: NICHOLAS GUILLEN COUPLE
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
1101YM0800XMental Health Counselor

General Provider Information

NPI Number : 1396699856
Entity Type Code : Individual
Provider Name (Legal Business Name) : NICHOLAS GUILLEN COUPLE
Provider Business Mailing Address
First Line : 2905 RIVER RD S
Second Line :
City : SALEM
State : OR
Zip : 97302-9754
Country : US
Telephone Number : 503-391-7175
Fax Number : 503-585-3303
Provider Business Practice Location Address
First Line : 2905 RIVER RD S
Second Line :
City : SALEM
State : OR
Zip : 97302-9754
Country : US
Telephone Number : 503-391-7175
Fax Number : 503-585-3303
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/23/2026
Last Update Date : 02/23/2026

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Directions to “ NICHOLAS GUILLEN COUPLE ” Practice Location

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