Provider Demographics
NPI:1952441313
Name:GUZMAN-VINCENT, VERONICA (GUIDANCE COUNSELOR)
Entity Type:Individual
Prefix:MRS
First Name:VERONICA
Middle Name:
Last Name:GUZMAN-VINCENT
Suffix:
Gender:F
Credentials:GUIDANCE COUNSELOR
Other - Prefix:
Other - First Name:VERONICA
Other - Middle Name:
Other - Last Name:VINCENT
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:GUIDANCE COUNSELOR
Mailing Address - Street 1:2184 W COUNTY 17TH ST
Mailing Address - Street 2:
Mailing Address - City:SOMERTON
Mailing Address - State:AZ
Mailing Address - Zip Code:85350-8236
Mailing Address - Country:US
Mailing Address - Phone:928-627-0249
Mailing Address - Fax:
Practice Address - Street 1:1453 NORTH MAIN ST. SUITE F
Practice Address - Street 2:
Practice Address - City:SAN LUIS
Practice Address - State:AZ
Practice Address - Zip Code:85349
Practice Address - Country:US
Practice Address - Phone:928-627-6567
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ3544046101YS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ879893OtherAHCCCS