Provider Demographics
NPI:1033182746
Name:GUERRA, SALLY EDWARDS (RN, LPC)
Entity Type:Individual
Prefix:MRS
First Name:SALLY
Middle Name:EDWARDS
Last Name:GUERRA
Suffix:
Gender:F
Credentials:RN, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:6625 WOOLDRIDGE RD
Mailing Address - Street 2:#201
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78414-2916
Mailing Address - Country:US
Mailing Address - Phone:361-510-3000
Mailing Address - Fax:361-334-5456
Practice Address - Street 1:6625 WOOLDRIDGE RD
Practice Address - Street 2:#201
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78414-2916
Practice Address - Country:US
Practice Address - Phone:361-510-3000
Practice Address - Fax:361-334-5456
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-12
Last Update Date:2013-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX13512101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX028008301Medicaid