Provider Demographics
NPI:1386299683
Name:GUILLEN, KATHYRIA (MS, TLMHC)
Entity type:Individual
Prefix:
First Name:KATHYRIA
Middle Name:
Last Name:GUILLEN
Suffix:
Gender:F
Credentials:MS, TLMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 N 27TH ST
Mailing Address - Street 2:
Mailing Address - City:FORT DODGE
Mailing Address - State:IA
Mailing Address - Zip Code:50501-4305
Mailing Address - Country:US
Mailing Address - Phone:319-433-0395
Mailing Address - Fax:319-433-3870
Practice Address - Street 1:5 N 27TH ST
Practice Address - Street 2:
Practice Address - City:FORT DODGE
Practice Address - State:IA
Practice Address - Zip Code:50501-4305
Practice Address - Country:US
Practice Address - Phone:319-433-0395
Practice Address - Fax:319-433-3870
Is Sole Proprietor?:No
Enumeration Date:2019-08-05
Last Update Date:2019-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA094253101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health