Provider Demographics
NPI:1982969747
Name:GUZMAN, ANGELICA MARIANA (LPC)
Entity Type:Individual
Prefix:
First Name:ANGELICA
Middle Name:MARIANA
Last Name:GUZMAN
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 1:3738 BROWNING BLF
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78245-2369
Mailing Address - Country:US
Mailing Address - Phone:210-875-1589
Mailing Address - Fax:
Practice Address - Street 1:2008 NW MILITARY HWY STE 1
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78213-2130
Practice Address - Country:US
Practice Address - Phone:210-875-1589
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-09
Last Update Date:2020-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX68325101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX330160802Medicaid