Provider Demographics
NPI:1912603002
Name:GUILLIOT, STEPHEN PAUL
Entity Type:Individual
Prefix:
First Name:STEPHEN
Middle Name:PAUL
Last Name:GUILLIOT
Suffix:
Gender:M
Credentials:
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 7856
Mailing Address - Street 2:
Mailing Address - City:AGAT
Mailing Address - State:GU
Mailing Address - Zip Code:96928-0856
Mailing Address - Country:US
Mailing Address - Phone:671-864-0730
Mailing Address - Fax:
Practice Address - Street 1:263 VIETNAM VETERANS MEMORIAL HWY
Practice Address - Street 2:
Practice Address - City:MANGILAO
Practice Address - State:GU
Practice Address - Zip Code:96913-0001
Practice Address - Country:US
Practice Address - Phone:671-647-8262
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-01
Last Update Date:2023-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GULPC-133101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health