Provider Demographics
NPI:1851050942
Name:GUCKENBURG, GINELLE (LMFT 147069)
Entity type:Individual
Prefix:
First Name:GINELLE
Middle Name:
Last Name:GUCKENBURG
Suffix:
Gender:F
Credentials:LMFT 147069
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1521 LOCUST AVE APT 1
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90813-5632
Mailing Address - Country:US
Mailing Address - Phone:909-684-0237
Mailing Address - Fax:
Practice Address - Street 1:2309 PACIFIC COAST HWY STE 104
Practice Address - Street 2:
Practice Address - City:HERMOSA BEACH
Practice Address - State:CA
Practice Address - Zip Code:90254-2752
Practice Address - Country:US
Practice Address - Phone:424-265-8001
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-12-15
Last Update Date:2024-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA147069101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health