Provider Demographics
NPI:1770044455
Name:MCGUIRE, MAC ARMSTRONG
Entity Type:Individual
Prefix:
First Name:MAC
Middle Name:ARMSTRONG
Last Name:MCGUIRE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:531 K ST
Mailing Address - Street 2:
Mailing Address - City:EUREKA
Mailing Address - State:CA
Mailing Address - Zip Code:95501-1165
Mailing Address - Country:US
Mailing Address - Phone:707-613-0439
Mailing Address - Fax:
Practice Address - Street 1:531 K ST
Practice Address - Street 2:
Practice Address - City:EUREKA
Practice Address - State:CA
Practice Address - Zip Code:95501-1165
Practice Address - Country:US
Practice Address - Phone:707-613-0439
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-26
Last Update Date:2024-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CANA171M00000X
171M00000X, 261QM0850X, 171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health