Provider Demographics
NPI:1679844187
Name:GUERRA, KATHY V (LPC)
Entity Type:Individual
Prefix:
First Name:KATHY
Middle Name:V
Last Name:GUERRA
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:KATHLEEN
Other - Middle Name:V
Other - Last Name:GUERRA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPC
Mailing Address - Street 1:1523 CERULEAN DR
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63146-3826
Mailing Address - Country:US
Mailing Address - Phone:314-560-5567
Mailing Address - Fax:
Practice Address - Street 1:11715 ADMINISTRATION DR
Practice Address - Street 2:SUITE 101
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63146-4600
Practice Address - Country:US
Practice Address - Phone:314-560-5567
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-01-16
Last Update Date:2012-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO001207101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional