Provider Demographics
NPI:1174649610
Name:GUERRA, JOSE LUIS (PSYD MFT)
Entity Type:Individual
Prefix:
First Name:JOSE
Middle Name:LUIS
Last Name:GUERRA
Suffix:
Gender:M
Credentials:PSYD MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 8401
Mailing Address - Street 2:
Mailing Address - City:LA CRESCENTA
Mailing Address - State:CA
Mailing Address - Zip Code:91224-0401
Mailing Address - Country:US
Mailing Address - Phone:818-770-6147
Mailing Address - Fax:
Practice Address - Street 1:3031 N SAN FERNANDO BLVD STE 100
Practice Address - Street 2:
Practice Address - City:BURBANK
Practice Address - State:CA
Practice Address - Zip Code:91504-4704
Practice Address - Country:US
Practice Address - Phone:818-770-6147
Practice Address - Fax:213-232-1008
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-22
Last Update Date:2021-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA32906103TC0700X
CALMFT50145106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical