Provider Demographics
NPI:1164938908
Name:GUILLAUME, JEAN DAVID I (MS)
Entity Type:Individual
Prefix:MR
First Name:JEAN
Middle Name:DAVID
Last Name:GUILLAUME
Suffix:I
Gender:M
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10454 SW 227TH TER
Mailing Address - Street 2:
Mailing Address - City:CUTLER BAY
Mailing Address - State:FL
Mailing Address - Zip Code:33190-1397
Mailing Address - Country:US
Mailing Address - Phone:305-928-9617
Mailing Address - Fax:
Practice Address - Street 1:13316 SW 128TH PSGE
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33186-5317
Practice Address - Country:US
Practice Address - Phone:305-772-1340
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-12-15
Last Update Date:2020-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLG45146472169-0101Y00000X
FLRBT-20-121376103K00000X, 106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst