Provider Demographics
NPI:1598974263
Name:GUILLOU, SUSAN E (MFT)
Entity Type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:E
Last Name:GUILLOU
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23717 HAWTHRONE BLVD
Mailing Address - Street 2:SUITE 107
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90505-5984
Mailing Address - Country:US
Mailing Address - Phone:310-375-4006
Mailing Address - Fax:310-539-4242
Practice Address - Street 1:23717 HAWTHRONE BLVD
Practice Address - Street 2:SUITE 107
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90505-5984
Practice Address - Country:US
Practice Address - Phone:310-375-4006
Practice Address - Fax:310-539-4242
Is Sole Proprietor?:No
Enumeration Date:2007-05-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC35256106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist