Provider Demographics
NPI:1831108364
Name:GUELZOW, MAUREEN G (LPC)
Entity Type:Individual
Prefix:
First Name:MAUREEN
Middle Name:G
Last Name:GUELZOW
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 E BURWELL ST
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:VA
Mailing Address - Zip Code:24153
Mailing Address - Country:US
Mailing Address - Phone:540-038-7310
Mailing Address - Fax:540-387-3653
Practice Address - Street 1:400 E BURWELL ST
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:VA
Practice Address - Zip Code:24153-4338
Practice Address - Country:US
Practice Address - Phone:540-038-7310
Practice Address - Fax:540-387-3653
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701001927101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
069767OtherVALUE OPTIONS
VA175024OtherANTHEM/ANTHEM HEALTHKEEP
213096OtherMAMSI/MDIPA
4673783OtherAETNA
080983OtherSENTARA/SOUTHERN HEALTH
1959121OtherFIRST HEALTH
14324OtherCIGNA