Provider Demographics
NPI:1053652313
Name:GUZMAN, JUAN JR (LPC)
Entity Type:Individual
Prefix:
First Name:JUAN
Middle Name:
Last Name:GUZMAN
Suffix:JR
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:522 S TEXAS BLVD
Mailing Address - Street 2:STE 116
Mailing Address - City:WESLACO
Mailing Address - State:TX
Mailing Address - Zip Code:78596-6202
Mailing Address - Country:US
Mailing Address - Phone:956-778-2150
Mailing Address - Fax:956-587-0014
Practice Address - Street 1:522 S TEXAS BLVD
Practice Address - Street 2:STE 116
Practice Address - City:WESLACO
Practice Address - State:TX
Practice Address - Zip Code:78596-6202
Practice Address - Country:US
Practice Address - Phone:956-778-2150
Practice Address - Fax:956-587-0014
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-12
Last Update Date:2016-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX67189101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX3145674-01Medicaid