Healthcare Provider Details

I. General information

NPI: 1851079503
Provider Name (Legal Business Name): MAYA LUCIA GUERRANT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/11/2023
Last Update Date: 03/11/2026
Certification Date: 03/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1108 BISSELL AVE
RICHMOND CA
94801-3135
US

IV. Provider business mailing address

1108 BISSELL AVE
RICHMOND CA
94801-3135
US

V. Phone/Fax

Practice location:
  • Phone: 510-231-1100
  • Fax:
Mailing address:
  • Phone: 510-231-1100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberAMFT138546
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: