Provider Demographics
NPI:1023378510
Name:AGUIRRE, MANUEL ANDRES JR (MA, LMFTA)
Entity type:Individual
Prefix:MR
First Name:MANUEL
Middle Name:ANDRES
Last Name:AGUIRRE
Suffix:JR
Gender:M
Credentials:MA, LMFTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2928 RUDDELL RD. SE APT. 117
Mailing Address - Street 2:
Mailing Address - City:LACEY
Mailing Address - State:WA
Mailing Address - Zip Code:98503
Mailing Address - Country:US
Mailing Address - Phone:323-896-8129
Mailing Address - Fax:
Practice Address - Street 1:3436 MARY ELDER RD. NE
Practice Address - Street 2:
Practice Address - City:OLYMPIA
Practice Address - State:WA
Practice Address - Zip Code:98506
Practice Address - Country:US
Practice Address - Phone:360-819-1741
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-05-18
Last Update Date:2024-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA107123106H00000X
WAMG61491335106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty