Provider Demographics
NPI:1598367203
Name:GUARDIOLA, LOUIS PABLO (MSCJ, CDCA)
Entity Type:Individual
Prefix:
First Name:LOUIS
Middle Name:PABLO
Last Name:GUARDIOLA
Suffix:
Gender:M
Credentials:MSCJ, CDCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:825 JUNE ST
Mailing Address - Street 2:
Mailing Address - City:FREMONT
Mailing Address - State:OH
Mailing Address - Zip Code:43420-3417
Mailing Address - Country:US
Mailing Address - Phone:567-280-4531
Mailing Address - Fax:
Practice Address - Street 1:825 JUNE ST
Practice Address - Street 2:
Practice Address - City:FREMONT
Practice Address - State:OH
Practice Address - Zip Code:43420-3417
Practice Address - Country:US
Practice Address - Phone:567-280-4531
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-09
Last Update Date:2020-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHCDCA.173177101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)