Healthcare Provider Details

I. General information

NPI: 1770775363
Provider Name (Legal Business Name): JOSEPH L HOLGUIN MA, LISAC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/16/2007
Last Update Date: 07/08/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8410 W THOMAS RD SUITE 116
PHOENIX AZ
85037-3329
US

IV. Provider business mailing address

8410 W THOMAS RD SUITE 116
PHOENIX AZ
85037-3329
US

V. Phone/Fax

Practice location:
  • Phone: 602-258-6797
  • Fax: 623-846-2191
Mailing address:
  • Phone: 602-258-6797
  • Fax: 623-846-2191

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number15045
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: