Provider Demographics
NPI:1760662910
Name:MCGUIRE, JOANNA LYNNE (MA)
Entity type:Individual
Prefix:
First Name:JOANNA
Middle Name:LYNNE
Last Name:MCGUIRE
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:406 MAIN ST
Mailing Address - Street 2:SUITE 112
Mailing Address - City:EDMONDS
Mailing Address - State:WA
Mailing Address - Zip Code:98020-3166
Mailing Address - Country:US
Mailing Address - Phone:415-851-4672
Mailing Address - Fax:
Practice Address - Street 1:406 MAIN ST
Practice Address - Street 2:SUITE 112
Practice Address - City:EDMONDS
Practice Address - State:WA
Practice Address - Zip Code:98020-3166
Practice Address - Country:US
Practice Address - Phone:415-851-4672
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-05
Last Update Date:2015-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALH00007593101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health