Healthcare Provider Details

I. General information

NPI: 1053741264
Provider Name (Legal Business Name): GERA MCGUIRE M.A., N.C.C., LMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/25/2013
Last Update Date: 05/12/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1174 MYRTLE AVE
ENUMCLAW WA
98022-3563
US

IV. Provider business mailing address

PO BOX 44
BLACK DIAMOND WA
98010-0044
US

V. Phone/Fax

Practice location:
  • Phone: 360-469-4179
  • Fax:
Mailing address:
  • Phone: 360-469-4179
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number60422606
License Number StateWA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: