Healthcare Provider Details

I. General information

NPI: 1851050942
Provider Name (Legal Business Name): GINELLE MELANIE GUCKENBURG LMFT 147069
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/15/2021
Last Update Date: 07/07/2026
Certification Date: 07/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24520 HAWTHORNE BLVD STE 210
TORRANCE CA
90505-6844
US

IV. Provider business mailing address

PO BOX 19
PORTOLA CA
96122-0019
US

V. Phone/Fax

Practice location:
  • Phone: 619-289-9068
  • Fax:
Mailing address:
  • Phone: 530-316-4248
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number147069
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: