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General NPI Number Information
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NPI Number | 1265725667
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Entity Type | Individual
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Provider Name | JENNIFER GUERRA LPC
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Gender | Female
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Dates
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Enumeration Date | 05/18/2011
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Last Update Date | 12/10/2020
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Provider Practice Location Address
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Address Line | 1400 SE 4TH ST STE A
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City | MOORE
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State | OK
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Zip | 73160-7328
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Country | US
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Telephone | 405-837-1033
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Fax |
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Provider Business Mailing Address
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Address Line | 720 W SUTHERLAND ST
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City | ALTUS
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State | OK
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Zip | 73521-3647
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Country | US
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Telephone | 580-471-4743
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 6445
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License Number State | OK
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