Provider Demographics
NPI:1356409395
Name:GUINN, JOHNNY LEE (MS)
Entity type:Individual
Prefix:MR
First Name:JOHNNY
Middle Name:LEE
Last Name:GUINN
Suffix:
Gender:M
Credentials:MS
Other - Prefix:MR
Other - First Name:JOHN
Other - Middle Name:L
Other - Last Name:GUINN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MS
Mailing Address - Street 1:5807 UNIVERSITY AVE STE A5290
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92115-6295
Mailing Address - Country:US
Mailing Address - Phone:619-228-1715
Mailing Address - Fax:
Practice Address - Street 1:4455 MURPHY CANYON RD
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92123-4379
Practice Address - Country:US
Practice Address - Phone:619-228-1715
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-04
Last Update Date:2013-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC 47578101YM0800X
MI4101006464101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health