Provider Demographics
NPI:1073255907
Name:GUZMAN, SAMUEL (LPC CANDIDATE)
Entity Type:Individual
Prefix:
First Name:SAMUEL
Middle Name:
Last Name:GUZMAN
Suffix:
Gender:M
Credentials:LPC CANDIDATE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1705 S ELDER AVE
Mailing Address - Street 2:
Mailing Address - City:BROKEN ARROW
Mailing Address - State:OK
Mailing Address - Zip Code:74012-6308
Mailing Address - Country:US
Mailing Address - Phone:918-316-3528
Mailing Address - Fax:
Practice Address - Street 1:2220 W HOUSTON ST STE D
Practice Address - Street 2:
Practice Address - City:BROKEN ARROW
Practice Address - State:OK
Practice Address - Zip Code:74012-3504
Practice Address - Country:US
Practice Address - Phone:918-409-0554
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-11
Last Update Date:2023-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty