Healthcare Provider Details

I. General information

NPI: 1932488525
Provider Name (Legal Business Name): GREGORY P GUERIN MA, LPC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/12/2011
Last Update Date: 05/24/2024
Certification Date: 05/24/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

154 ALBANY AVE
SHREVEPORT LA
71105-2102
US

IV. Provider business mailing address

154 ALBANY AVE
SHREVEPORT LA
71105-2102
US

V. Phone/Fax

Practice location:
  • Phone: 318-349-5590
  • Fax: 833-851-7335
Mailing address:
  • Phone: 318-349-5590
  • Fax: 833-851-7335

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number3196
License Number StateLA
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number3196
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: