Provider Demographics
NPI:1952786972
Name:NAMBO-BASUA, GUADALUPE MARIE (LMFT)
Entity type:Individual
Prefix:
First Name:GUADALUPE
Middle Name:MARIE
Last Name:NAMBO-BASUA
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:GUADALUPE
Other - Middle Name:M
Other - Last Name:NAMBO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3436 AMERICAN RIVER DR STE 8A
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95864-5793
Mailing Address - Country:US
Mailing Address - Phone:916-237-7457
Mailing Address - Fax:
Practice Address - Street 1:3436 AMERICAN RIVER DR STE 8A
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95864-5793
Practice Address - Country:US
Practice Address - Phone:916-237-7457
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-21
Last Update Date:2025-02-13
Deactivation Date:2021-01-12
Deactivation Code:
Reactivation Date:2022-03-24
Provider Licenses
StateLicense IDTaxonomies
CA1110850106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist