Provider Demographics
NPI:1629698667
Name:MCGURN, ILIANA
Entity Type:Individual
Prefix:
First Name:ILIANA
Middle Name:
Last Name:MCGURN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6613 FOREST GRV
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78240-3315
Mailing Address - Country:US
Mailing Address - Phone:210-306-6780
Mailing Address - Fax:
Practice Address - Street 1:6613 FOREST GRV
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78240-3315
Practice Address - Country:US
Practice Address - Phone:210-306-6780
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-20
Last Update Date:2020-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX580051041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical