Provider Demographics
NPI:1760107973
Name:ULLOA, GUILLERMO DANIEL (LMFT)
Entity Type:Individual
Prefix:MR
First Name:GUILLERMO
Middle Name:DANIEL
Last Name:ULLOA
Suffix:
Gender:M
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:650 SIERRA MADRE VILLA AVE STE 110
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91107-2040
Mailing Address - Country:US
Mailing Address - Phone:626-351-9616
Mailing Address - Fax:626-351-9493
Practice Address - Street 1:650 SIERRA MADRE VILLA AVE STE 110
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91107-2040
Practice Address - Country:US
Practice Address - Phone:626-351-9616
Practice Address - Fax:626-351-9493
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-10
Last Update Date:2022-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA53213106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist