Provider Demographics
NPI:1629321799
Name:GUERRERO, SHOSHANNAH (LMFT)
Entity type:Individual
Prefix:
First Name:SHOSHANNAH
Middle Name:
Last Name:GUERRERO
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2575 58TH ST LOT 9
Mailing Address - Street 2:
Mailing Address - City:VINTON
Mailing Address - State:IA
Mailing Address - Zip Code:52349-9355
Mailing Address - Country:US
Mailing Address - Phone:877-989-4255
Mailing Address - Fax:877-989-4255
Practice Address - Street 1:2575 58TH ST LOT 9
Practice Address - Street 2:
Practice Address - City:VINTON
Practice Address - State:IA
Practice Address - Zip Code:52349-9355
Practice Address - Country:US
Practice Address - Phone:877-989-4255
Practice Address - Fax:319-398-3501
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-26
Last Update Date:2024-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA000386101YM0800X
106H00000X
IA000380106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0075475Medicaid