Provider Demographics
NPI:1306115951
Name:GUILLEN, ANDREW RYAN
Entity type:Individual
Prefix:
First Name:ANDREW
Middle Name:RYAN
Last Name:GUILLEN
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 1:2161 RUNNING RIVER RD
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89074-4230
Mailing Address - Country:US
Mailing Address - Phone:702-300-3606
Mailing Address - Fax:
Practice Address - Street 1:6655 W SAHARA AVE
Practice Address - Street 2:A-110
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89146-0842
Practice Address - Country:US
Practice Address - Phone:702-365-0600
Practice Address - Fax:702-365-0602
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-27
Last Update Date:2011-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No101Y00000XBehavioral Health & Social Service ProvidersCounselor