Provider Demographics
NPI:1578771259
Name:GUILLEN, CANDACE Y (LBSW)
Entity Type:Individual
Prefix:MS
First Name:CANDACE
Middle Name:Y
Last Name:GUILLEN
Suffix:
Gender:F
Credentials:LBSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6403 BOX
Mailing Address - Street 2:309 W. ANGELITA DR
Mailing Address - City:LA FERIA
Mailing Address - State:TX
Mailing Address - Zip Code:78559-2640
Mailing Address - Country:US
Mailing Address - Phone:956-793-2264
Mailing Address - Fax:956-542-1913
Practice Address - Street 1:6403 BOX
Practice Address - Street 2:309 W. ANGELITA DR
Practice Address - City:LA FERIA
Practice Address - State:TX
Practice Address - Zip Code:78559-2640
Practice Address - Country:US
Practice Address - Phone:956-793-2264
Practice Address - Fax:956-542-1913
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX26924104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker