Provider Demographics
NPI:1770775363
Name:HOLGUIN, JOSEPH L (MA, LISAC)
Entity type:Individual
Prefix:MR
First Name:JOSEPH
Middle Name:L
Last Name:HOLGUIN
Suffix:
Gender:M
Credentials:MA, LISAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8410 W THOMAS RD
Mailing Address - Street 2:SUITE 116
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85037-3329
Mailing Address - Country:US
Mailing Address - Phone:602-258-6797
Mailing Address - Fax:623-846-2191
Practice Address - Street 1:8410 W THOMAS RD
Practice Address - Street 2:SUITE 116
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85037-3329
Practice Address - Country:US
Practice Address - Phone:602-258-6797
Practice Address - Fax:623-846-2191
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-16
Last Update Date:2015-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ15045101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)