Provider Demographics
NPI:1184196321
Name:PINA, GUILLERMO (AMFT140631)
Entity type:Individual
Prefix:
First Name:GUILLERMO
Middle Name:
Last Name:PINA
Suffix:
Gender:M
Credentials:AMFT140631
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:450 E SAN JACINTO AVE
Mailing Address - Street 2:
Mailing Address - City:PERRIS
Mailing Address - State:CA
Mailing Address - Zip Code:92571-2833
Mailing Address - Country:US
Mailing Address - Phone:951-236-5193
Mailing Address - Fax:
Practice Address - Street 1:450 E SAN JACINTO AVE
Practice Address - Street 2:
Practice Address - City:PERRIS
Practice Address - State:CA
Practice Address - Zip Code:92571-2833
Practice Address - Country:US
Practice Address - Phone:951-236-5193
Practice Address - Fax:951-784-4976
Is Sole Proprietor?:No
Enumeration Date:2018-12-28
Last Update Date:2023-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA4120101YP2500X
171M00000X
CAAMFT140631106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No171M00000XOther Service ProvidersCase Manager/Care Coordinator