Provider Demographics
NPI:1518506963
Name:GUAJARDO, JOSEPH ALAN (LPC)
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:ALAN
Last Name:GUAJARDO
Suffix:
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 1:166 HOLLY RD
Mailing Address - Street 2:
Mailing Address - City:BATTLE CREEK
Mailing Address - State:MI
Mailing Address - Zip Code:49017-8851
Mailing Address - Country:US
Mailing Address - Phone:517-425-1439
Mailing Address - Fax:
Practice Address - Street 1:30 N HOWELL ST STE 21A
Practice Address - Street 2:
Practice Address - City:HILLSDALE
Practice Address - State:MI
Practice Address - Zip Code:49242-1621
Practice Address - Country:US
Practice Address - Phone:517-425-1601
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-02
Last Update Date:2021-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401014330101Y00000X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional