Provider Demographics
NPI:1316658016
Name:GUERRA WALENDOWSKY, THAIS
Entity type:Individual
Prefix:
First Name:THAIS
Middle Name:
Last Name:GUERRA WALENDOWSKY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:TAIS
Other - Middle Name:
Other - Last Name:GUERRA-WALENDOWSKY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LLPC, ATR-P
Mailing Address - Street 1:22289 SHANE DR
Mailing Address - Street 2:
Mailing Address - City:MACOMB
Mailing Address - State:MI
Mailing Address - Zip Code:48042-3820
Mailing Address - Country:US
Mailing Address - Phone:616-990-5843
Mailing Address - Fax:
Practice Address - Street 1:35429 SHOENHERR RD
Practice Address - Street 2:
Practice Address - City:STERLING HEIGHTS
Practice Address - State:MI
Practice Address - Zip Code:48312-4258
Practice Address - Country:US
Practice Address - Phone:586-303-2255
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-12-13
Last Update Date:2024-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
171M00000X
MI6451023645101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No171M00000XOther Service ProvidersCase Manager/Care Coordinator