Provider Demographics
NPI:1598912982
Name:GUAJARDO, ANGELICA (FT, LMFT)
Entity Type:Individual
Prefix:MS
First Name:ANGELICA
Middle Name:
Last Name:GUAJARDO
Suffix:
Gender:F
Credentials:FT, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:78030 CALLE BARCELONA STE D
Mailing Address - Street 2:
Mailing Address - City:LA QUINTA
Mailing Address - State:CA
Mailing Address - Zip Code:92253-2996
Mailing Address - Country:US
Mailing Address - Phone:760-702-8856
Mailing Address - Fax:
Practice Address - Street 1:78030 CALLE BARCELONA STE D
Practice Address - Street 2:
Practice Address - City:LA QUINTA
Practice Address - State:CA
Practice Address - Zip Code:92253-2996
Practice Address - Country:US
Practice Address - Phone:760-610-9650
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-27
Last Update Date:2018-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA51740106H00000X
CAMFC 51740106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist