Provider Demographics
NPI:1871564138
Name:GUERRA, MABEL L (LCSW)
Entity type:Individual
Prefix:MRS
First Name:MABEL
Middle Name:L
Last Name:GUERRA
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MS
Other - First Name:MABEL
Other - Middle Name:L
Other - Last Name:MICKLE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LCSW
Mailing Address - Street 1:14901 WINDWARD DRIVE
Mailing Address - Street 2:101
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78418
Mailing Address - Country:US
Mailing Address - Phone:361-549-3024
Mailing Address - Fax:
Practice Address - Street 1:1650 COCHRANE CIR
Practice Address - Street 2:
Practice Address - City:FORT CARSON
Practice Address - State:CO
Practice Address - Zip Code:80913-4603
Practice Address - Country:US
Practice Address - Phone:361-549-3024
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACSW0020161041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical