Healthcare Provider Details

I. General information

NPI: 1417018763
Provider Name (Legal Business Name): MRS. AILEEN GUERRA-MORALES
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/12/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

789 N CLARE AVE
HARRISON MI
48625-9194
US

IV. Provider business mailing address

211 W DUNLOP RD
CLARE MI
48617-1741
US

V. Phone/Fax

Practice location:
  • Phone: 989-539-2141
  • Fax: 989-539-2143
Mailing address:
  • Phone: 989-386-3826
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number6401009716
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: