Provider Demographics
NPI:1053741264
Name:MCGUIRE, GERA (MA, NCC, LMHC)
Entity type:Individual
Prefix:
First Name:GERA
Middle Name:
Last Name:MCGUIRE
Suffix:
Gender:F
Credentials:MA, NCC, LMHC
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 44
Mailing Address - Street 2:
Mailing Address - City:BLACK DIAMOND
Mailing Address - State:WA
Mailing Address - Zip Code:98010-0044
Mailing Address - Country:US
Mailing Address - Phone:360-469-4179
Mailing Address - Fax:
Practice Address - Street 1:1174 MYRTLE AVE
Practice Address - Street 2:
Practice Address - City:ENUMCLAW
Practice Address - State:WA
Practice Address - Zip Code:98022-3563
Practice Address - Country:US
Practice Address - Phone:360-469-4179
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-25
Last Update Date:2014-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA60422606101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health