Provider Demographics
NPI:1669281713
Name:GUAJARDO, SELINA MARIE (LPC)
Entity type:Individual
Prefix:
First Name:SELINA
Middle Name:MARIE
Last Name:GUAJARDO
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1101 E LOCUST AVE
Mailing Address - Street 2:
Mailing Address - City:VICTORIA
Mailing Address - State:TX
Mailing Address - Zip Code:77901-4128
Mailing Address - Country:US
Mailing Address - Phone:956-393-1762
Mailing Address - Fax:
Practice Address - Street 1:1101 E LOCUST AVE
Practice Address - Street 2:
Practice Address - City:VICTORIA
Practice Address - State:TX
Practice Address - Zip Code:77901-4128
Practice Address - Country:US
Practice Address - Phone:956-393-1762
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-03
Last Update Date:2025-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX86749101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health