Provider Demographics
NPI:1255012738
Name:GUERRA, CHANEL (MFT-TRAINEE)
Entity type:Individual
Prefix:
First Name:CHANEL
Middle Name:
Last Name:GUERRA
Suffix:
Gender:F
Credentials:MFT-TRAINEE
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 3280
Mailing Address - Street 2:
Mailing Address - City:VISALIA
Mailing Address - State:CA
Mailing Address - Zip Code:93278-3280
Mailing Address - Country:US
Mailing Address - Phone:559-604-0441
Mailing Address - Fax:
Practice Address - Street 1:1500 S MOONEY BLVD
Practice Address - Street 2:
Practice Address - City:VISALIA
Practice Address - State:CA
Practice Address - Zip Code:93277-4403
Practice Address - Country:US
Practice Address - Phone:559-604-0441
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-27
Last Update Date:2023-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist