Provider Demographics
NPI:1659676310
Name:GUZMAN-WEAVER, ALLEGRA LEIGH (LIMHP)
Entity Type:Individual
Prefix:
First Name:ALLEGRA
Middle Name:LEIGH
Last Name:GUZMAN-WEAVER
Suffix:
Gender:F
Credentials:LIMHP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4001 LEAVENWORTH ST
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68105-1026
Mailing Address - Country:US
Mailing Address - Phone:402-884-7223
Mailing Address - Fax:402-884-7152
Practice Address - Street 1:4001 LEAVENWORTH ST
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68105-1026
Practice Address - Country:US
Practice Address - Phone:402-884-7223
Practice Address - Fax:402-884-7152
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-11
Last Update Date:2013-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1102101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health