MEDICARE: CONCHANTA GUINES LMFT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106H00000X	Marriage & Family Therapist		IN

General Provider Information

NPI Number	:	1851118095
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CONCHANTA GUINES LMFT

Provider Business Mailing Address
First Line	:	4663 WELTON ST
Second Line	:
City	:	GREENWOOD
State	:	IN
Zip	:	46143-8974
Country	:	US
Telephone Number	:	317-662-0795
Fax Number	:

Provider Business Practice Location Address
First Line	:	5651 COVENTRY LN # 112
Second Line	:
City	:	FORT WAYNE
State	:	IN
Zip	:	46804-7145
Country	:	US
Telephone Number	:	260-205-8644
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/19/2024
Last Update Date	:	06/08/2026

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Directions to “ CONCHANTA GUINES LMFT” Practice Location

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