Provider Demographics
NPI:1831649367
Name:GU, JIEUN (M A, LPC)
Entity Type:Individual
Prefix:
First Name:JIEUN
Middle Name:
Last Name:GU
Suffix:
Gender:F
Credentials:M A, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1859 N 52ND ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19131-3310
Mailing Address - Country:US
Mailing Address - Phone:612-655-9753
Mailing Address - Fax:
Practice Address - Street 1:1859 N 52ND ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19131-3310
Practice Address - Country:US
Practice Address - Phone:612-655-9753
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-10-07
Last Update Date:2023-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
PAPC016070101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health