Provider Demographics
NPI:1013435288
Name:GUERECA, MIREN ITZIAR
Entity Type:Individual
Prefix:
First Name:MIREN
Middle Name:ITZIAR
Last Name:GUERECA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6250 W NORTH AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60639-3861
Mailing Address - Country:US
Mailing Address - Phone:773-622-6218
Mailing Address - Fax:773-622-7440
Practice Address - Street 1:6250 W NORTH AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60639-3861
Practice Address - Country:US
Practice Address - Phone:773-622-6218
Practice Address - Fax:773-622-7440
Is Sole Proprietor?:No
Enumeration Date:2017-09-07
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL178013120101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional