Provider Demographics
NPI:1992146518
Name:MCGUIRE NELSON, JANEEN (MFT)
Entity type:Individual
Prefix:
First Name:JANEEN
Middle Name:
Last Name:MCGUIRE NELSON
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 854
Mailing Address - Street 2:
Mailing Address - City:ISSAQUAH
Mailing Address - State:WA
Mailing Address - Zip Code:98027-0031
Mailing Address - Country:US
Mailing Address - Phone:425-392-3652
Mailing Address - Fax:
Practice Address - Street 1:17 NW ALDER PL
Practice Address - Street 2:SUITE 204
Practice Address - City:ISSAQUAH
Practice Address - State:WA
Practice Address - Zip Code:98027-3200
Practice Address - Country:US
Practice Address - Phone:425-392-3652
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-11
Last Update Date:2013-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALF00001685106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist