Healthcare Provider Details

I. General information

NPI: 1851118095
Provider Name (Legal Business Name): CONCHANTA GUINES LMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/19/2024
Last Update Date: 06/08/2026
Certification Date: 06/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5651 COVENTRY LN # 112
FORT WAYNE IN
46804-7145
US

IV. Provider business mailing address

4663 WELTON ST
GREENWOOD IN
46143-8974
US

V. Phone/Fax

Practice location:
  • Phone: 260-205-8644
  • Fax:
Mailing address:
  • Phone: 317-662-0795
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: