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General NPI Number Information
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NPI Number | 1841894185
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Entity Type | Individual
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Provider Name | JUSTINA GUIRGUIS LMFT
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Gender | Female
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Dates
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Enumeration Date | 11/27/2020
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Last Update Date | 10/24/2024
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Provider Practice Location Address
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Address Line | 2275 S MAIN ST STE 201
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City | CORONA
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State | CA
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Zip | 92882-5303
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Country | US
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Telephone | 951-279-3222
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Fax | 951-279-5222
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Provider Business Mailing Address
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Address Line | 8155 E 30TH ST
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City | INDIANAPOLIS
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State | IN
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Zip | 46219-1342
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Country | US
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Telephone | 317-853-7514
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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 | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | LMFT147443
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License Number State | CA
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