Healthcare Provider Details

I. General information

NPI: 1649692831
Provider Name (Legal Business Name): JANINE RENEE GUASTELLA MA LLP LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/08/2014
Last Update Date: 02/17/2025
Certification Date: 02/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8801 MAYFLOWER DRIVE
PLYMOUTH MI
48170
US

IV. Provider business mailing address

8801 MAYFLOWER DRIVE
PLYMOUTH MI
48170
US

V. Phone/Fax

Practice location:
  • Phone: 616-856-8028
  • Fax:
Mailing address:
  • Phone: 616-856-8028
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number6401222858
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number6361006058
License Number StateMI
# 3
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number6401222858
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: