Provider Demographics
NPI:1780707190
Name:GUZA, JOHN NICHOLAS (PHD)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:NICHOLAS
Last Name:GUZA
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:104 E MAIN ST STE 409
Mailing Address - Street 2:
Mailing Address - City:BOZEMAN
Mailing Address - State:MT
Mailing Address - Zip Code:59715-4787
Mailing Address - Country:US
Mailing Address - Phone:406-585-0015
Mailing Address - Fax:
Practice Address - Street 1:104 E MAIN ST STE 409
Practice Address - Street 2:
Practice Address - City:BOZEMAN
Practice Address - State:MT
Practice Address - Zip Code:59715-4787
Practice Address - Country:US
Practice Address - Phone:406-585-0015
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT252103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist