Provider Demographics
NPI:1407694946
Name:PLACER, GUINEVERE (LCSW)
Entity type:Individual
Prefix:
First Name:GUINEVERE
Middle Name:
Last Name:PLACER
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6107 E GRANT RD
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85712-5828
Mailing Address - Country:US
Mailing Address - Phone:520-722-9631
Mailing Address - Fax:520-722-9676
Practice Address - Street 1:2601 N CAMPBELL AVE STE 205
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85719-3167
Practice Address - Country:US
Practice Address - Phone:207-229-6315
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-18
Last Update Date:2024-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLCSW-15842101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)