Provider Demographics
NPI:1043619810
Name:GUILLOUX, JEAN WESNER
Entity Type:Individual
Prefix:
First Name:JEAN WESNER
Middle Name:
Last Name:GUILLOUX
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1054 FILBERT ST
Mailing Address - Street 2:
Mailing Address - City:STEPHENS CITY
Mailing Address - State:VA
Mailing Address - Zip Code:22655-2614
Mailing Address - Country:US
Mailing Address - Phone:304-840-5789
Mailing Address - Fax:
Practice Address - Street 1:1054 FILBERT ST
Practice Address - Street 2:
Practice Address - City:STEPHENS CITY
Practice Address - State:VA
Practice Address - Zip Code:22655-2614
Practice Address - Country:US
Practice Address - Phone:304-840-5789
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-18
Last Update Date:2014-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health