Provider Demographics
NPI:1134775372
Name:GUATEMALA, NANCY (AMFT)
Entity type:Individual
Prefix:
First Name:NANCY
Middle Name:
Last Name:GUATEMALA
Suffix:
Gender:F
Credentials:AMFT
Other - Prefix:
Other - First Name:NANCY
Other - Middle Name:
Other - Last Name:SIQUINA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:17407 SHERMAN WAY
Mailing Address - Street 2:
Mailing Address - City:VAN NUYS
Mailing Address - State:CA
Mailing Address - Zip Code:91406-3505
Mailing Address - Country:US
Mailing Address - Phone:818-304-1311
Mailing Address - Fax:
Practice Address - Street 1:20501 VENTURA BLVD STE 170
Practice Address - Street 2:
Practice Address - City:WOODLAND HILLS
Practice Address - State:CA
Practice Address - Zip Code:91364-6258
Practice Address - Country:US
Practice Address - Phone:818-657-0411
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-14
Last Update Date:2023-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
CA138397106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program