Provider Demographics
NPI:1982221248
Name:AGUON, MARIA TERESA PEREDA (LPC)
Entity Type:Individual
Prefix:MRS
First Name:MARIA TERESA
Middle Name:PEREDA
Last Name:AGUON
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1589
Mailing Address - Street 2:
Mailing Address - City:HAGATNA
Mailing Address - State:GU
Mailing Address - Zip Code:96932-1589
Mailing Address - Country:US
Mailing Address - Phone:671-482-0091
Mailing Address - Fax:
Practice Address - Street 1:790 GOV CARLOS G CAMACHO RD
Practice Address - Street 2:
Practice Address - City:TAMUNING
Practice Address - State:GU
Practice Address - Zip Code:96913-3129
Practice Address - Country:US
Practice Address - Phone:671-647-5351
Practice Address - Fax:671-647-5414
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-02
Last Update Date:2020-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GULPC-143101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health