Provider Demographics
NPI:1316549298
Name:GUILBEAU, MYRA Y (CHW)
Entity Type:Individual
Prefix:MISS
First Name:MYRA
Middle Name:Y
Last Name:GUILBEAU
Suffix:
Gender:F
Credentials:CHW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1422 SWEET GRASS TRL
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77090-1845
Mailing Address - Country:US
Mailing Address - Phone:183-229-8603
Mailing Address - Fax:
Practice Address - Street 1:1422 SWEET GRASS TRL
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77090-1845
Practice Address - Country:US
Practice Address - Phone:832-298-6034
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-14
Last Update Date:2020-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX14077172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker